Applegate @ Drummond

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 11:55 a.m. Upon arrival, LPA Mosley was greeted by staff, the Administrator, Emma Carmona and Licensee Representative, Irma Carmona and informed them of the reason for the visit. Entrance interview. The LPA and Administrator 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. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 1:54 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 04/03/2025. The emergency exiting plans/sketch are posted. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 11/20/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened and is non-functional. There is a functioning telephone on the premises. Auditory alarms at the entrances and exits were observed and functional at the time of the visit. INTERVIEWS: Starting at 11:58 a.m. and throughput the visit one (1) staff and one (1) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff rooms. The staff room is kept locked at all times and observed to be occupied by staff. Six (6) out of six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are six (6) total restrooms. One (1) is designated as a shared / common resident restroom, and four (4) are designated as a private resident restrooms, and One (1) is designated as staff / guest restroom. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 107.8- 118.2 degrees Fahrenheit, all within the required range. LPA observed storage space closets in the hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area at 12:13 p.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 118.0 degrees Fahrenheit. Cleaning supplies and other chemicals are kept in the garage, locked and inaccessible to residents in care. LAUNDRY ROOM: LPA observed the locked laundry room adjacent to the kitchen and entrance to the garage. Laundry room has a washer and dryer and is kept locked at all times. GARAGE / OFFICE: LPA observed the facility garage adjacent to the kitchen accessible through the laundry room, which was locked at the time of the visit. The garage is used as an office area which contained emergency food and water, emergency supplies, an extra refrigerator/freezer that was checked for proper labels and expiration dates. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... BACKYARD: The entire property is fenced. The backyard has a patio area with a portable unbrealla for shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. There is a locked storage shed in the back yard inaccessible to residents. Only one (1) pathway is used as an emergency exit which was free of obstructions at the time of the visit. RECORDS: Resident Records: were reviewed beginning at 12:24 p.m. Five (5) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 12:58 p.m. four (4) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 1:40 p.m. Medications are centrally stored and locked in a closet in the kitchen adjacent to the laundry room. Medications for two (2) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. LPA observed the first aid supplies to be complete, including a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster and copy of the Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Dec 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:35AM The LPA was greeted by staff and informed them of the reason for today's visit. Administrator Emma Carmona arrived at 10:15AM. Entrance interview conducted. Beginning at 10:26AM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: Knives were observed in a locked drawer, cleaning supplies were locked and stored inaccessible in an under-sink cabinet. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food; all food was observed to be of good quality. GARAGE: Adjacent to the facility kitchen is a locked garage. There is a laundry area where the washer and dryer are held, laundry supplies and cleaning supplies are kept locked. Resident personal care items were observed stored in the locked garage. There is a pantry with additional non-perishable food items and a refrigerator/freezer with additional perishable food items all food was observed be of good quality. There is a sufficient supply of emergency food and water kept in the garage. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature throughout the visit. Hardwired combination smoke and carbon monoxide detectors were tested at 11:49AM and were operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 03/19/2024. The LPA observed the required postings throughout the common spaces. Auditory alarms were observed on all exit doors and functioned properly. BEDROOMS: There are six (6) designated resident bedrooms and one (1) staff bedroom. All bedrooms were Report Continued on LIC 809-C furnished appropriately, and contained clean linens, appropriate furnishings and sufficient lighting. Additional linens are kept in the closets located in the hallways. BATHROOMS: The five (5) resident bathrooms and one (1) visitor/staff bathroom were clean, sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature in resident bathrooms measured within the required range. OUTDOOR AREA: The backyard has an outdoor area equipped with furniture and shade for resident use. There is a side gate for emergency exit and is single latched. No bodies of water noted. RECORDS: Personnel records were reviewed for, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. MEDICATIONS: Medications review began at 11:55AM; medications are centrally stored and locked in a closet in the kitchen to the right of refrigerator. Medications are labeled and checked for expiration dates, prescription numbers and date filled. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly with the last drill documented on 11/26/2024. No deficiencies cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 11, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 10:00 a.m. The LPA was greeted by staff, Administrator Irma Carmona arrived shortly thereafter and informed them of the reason for the visit. The LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA began the inspection in the Kitchen/food service area at approximately 10:20 a.m. Knives and cleaning supplies are locked and stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food all food was observed to be of good quality. GARAGE: The garage is attached to the home. Access to the garage is through the kitchen. There is a laundry area located in the garage where the washer and dryer are held, laundry supplies and cleaning supplies are kept locked. There is a pantry with additional non-perishable food items and a refrigerator freezer with additional perishable food items all food was observed be of good quality. There is a sufficient supply of emergency food and water kept in the garage. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 75 degrees. The smoke detector(s) and carbon monoxide detector(s) were tested at 11:05 a.m. and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced March 21, 2023. The LPA observed the required postings throughout the common spaces. **Continued on LIC 809-C** BEDROOMS: There are six (6) designated resident bedrooms and one (1) staff bedroom. All bedrooms were furnished appropriately, and up kept with clean linens, appropriate furnishings and sufficient lighting. Additional linens are kept in the closet located in the hallways. BATHROOMS: The five (5) resident bathrooms and one (1) visitor/staff bathroom were clean, sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature in bathrooms measured between 112.4-114.4 degrees Fahrenheit. OUTDOOR AREA: The backyard has an outdoor area equipped with furniture and shade for client use. There is a side gate for emergency exit and is single latched. No bodies of water noted. RECORDS: Personnel records review began at 11:15 a.m., records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. MEDICATIONS: Medications review began at 12:20 p.m.; medications are centrally stored and locked in a closet in the kitchen to the right of refrigerator. Medications are labeled and checked for expiration dates, prescription numbers and date filled. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. 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 LPA obtained the following documents: - LIC9020 Client Roster - Liability Insurance No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Dec 20, 2023