Andrea's Board & Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 9:15 a.m. to conduct a 1-year required annual visit. LPA met with Andrea Rivera, Administrator. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: LPA toured resident rooms and observed that rooms were tidy, the lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational. The showers have non-skid mats. The pathways are clear of any obstructions. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for residents’ use. The fire extinguisher was last charged and inspected on 8/11/25. The carbon monoxide and smoke detector was tested and working. Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents. There is a hospice waiver for 1 resident. Staffing and Training: The facility currently employs 5 staff and 1 administrator. Files reviewed had current 1st Aid/CPR. Files had all required documents per regulation standards. Administrator Certification expires 05/31/2027. Training for 2025 was reviewed and completed. Continued on 809-C Resident Records & Incident Reports: The facility keeps separate confidential files on each resident. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physician reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms. All forms were legible and complete. Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were reviewed. The facility conducted a quarterly disaster drill on 10/18/25. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Exit interview conducted and copy of report printed.the state’s words, verbatim · CDSS document, Nov 19, 2025

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erika Miller arrived at 1:30 p.m. to conduct a 1-year required annual visit. LPA met with Andrea Rivera, Administrator. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has at least a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: LPA toured resident rooms and observed that rooms were tidy, the lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for resident use. The fire extinguisher was last charged and inspected on 8/28/24. The carbon monoxide and smoke detector were tested and working. Continued on 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents. There is a hospice waiver for 1 resident. Staffing: The facility currently employs 5 staff and 1 administrator. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physician reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms. All forms were legible. Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed residents’ medications, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill on 10/13/24. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Exit interview conducted and copy of report printed.the state’s words, verbatim · CDSS document, Oct 24, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jenny Olson arrived at the facility unannounced to conduct a required annual visit at 10:20 a.m. When LPA arrived, there were two staff and four residents present. LPA was greeted by Administrator and staff and informed them of the reason for the visit. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives are stored in a locked drawer in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Common areas: Living and dining room furniture were observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. At 11:00 a.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. LPA observed required postings throughout the common space. The fire extinguisher was charged and serviced 8/28/2023. The backyard has a covered outdoor area equipped with furniture for client use. No bodies of water noted. The washer and dryer are in the garage. The garage is unlocked. Restrooms: The three resident restrooms were clean and sanitary and in operating condition with non-skid mats. The bathrooms were sufficiently stocked with soap and paper towels. Bedrooms: There are five (5) resident rooms, which were furnished. A linen closet was located outside of the rooms, which stocked extra linens and towels. Records: LPA reviewed resident and staff records around 10:30 a.m. LPA reviewed five (5) resident files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, and current needs and services plan. All files were complete. Continued on 809-C LPA reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. All files were complete. MEDICATIONS: Medications review began at 12:30 p.m. The medications are centrally stored and locked in a cabinet in the kitchen. Medications are labeled and checked for expiration dates. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. At 1:15 p.m., LPA interviewed two (2) staff members and two (2) residents. During today’s visit, the LPA obtained copies of the following: staff roster and current liability insurance. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 1, 2023

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.