Familycare Cottage II

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Erica Mosley conducted a Case Management - Incident visit to follow up on a self-reported incident which took place on 1/4/2026. At 9:46 a.m. LPA Mosley was greeted by staff who called the Administrator. LPA met with Marisol Flamenco, Administrator and Magdalena Garcia, Assistant Administrator and the reason for the visit was explained. Entrance interview. On 01/04/2026 it was reported that at approx. 3:20 p.m. Staff #1 (S1) called the Administrator to inform them that it has been about 15 minutes and Staff #2 (S2) has not yet shown up to their scheduled shift and they had to leave. At that time the Assistant Administrator made calls to find coverage and Administrator was less than 15 minutes away and drove to the facility. Once the Administrator arrived to the facility at approx 3:35 p.m. they noted seeing S1 on their bike two (2) houses down. The Administrator immediately checked on the welfare and well-being of the residents, no injuries or incidents were noted. The Administrator called Licensing leaving a voicemail briefly informing them of the incident and request a call back. Subsequently S1 was terminated for not following the facility policy : Residents Must Not Be Left Unattended and all staff received an in service training regarding the same policy. During today's visit, from 9:50 a.m. LPA and staff conducted a physical plant tour to ensure there were no immediate health and safety concerns. Starting at 10:00 a.m and throughout the visit LPA conducted four (4) in person staff interviews including the Assistant Administrator and Administrator, four (4) resident interviews and record review along with obtained copies of pertinent documents relevant to the incident. Report Continued on LIC 809C... Report Continued from LIC 809... Interviews with the staff revealed that they are not allowed to leave the residents unattended. If a staff is running late they must notify administrative staff immediately. The administrative staff typically find coverage relatively fast. They were not present on the incident date of 01/04/2026. They recently received an in service training regarding the facility policy : Residents Must Not Be Left Unattended. Interview with the Administrator revealed that on the day of the incident, 01/04/2026 they received a call from S1 informing them that S2 has not yet arrived for their shift and that they had to leave. The Administrator called the Assistant Administrator to get a hold of S2 and being finding coverage while they drove to the facility with the intention to relieve S1. They were about 13 minutes away from the facility and when they arrived they saw S1 on their bike two (2) houses down. They immediately checked on all the residents safety and well being, no injuries or incidents were observed or noted. It was noted that all five (5) residents at the time were on the couch in the living room, watching the television. Interviews with the residents revealed that they were unaware of being unattended. To their knowledge they are never left unattended and staff are always available to them. They are happy with the care they are provided and no concerns were noted or voiced. Record review and interviews support that there has not been any past incidents related to supervision. In service training was conducted from 01/08/2026 - 01/11/2026 to cover all shifts on the facility policy: Residents Must Not Be Left Unattended with a signed statement of acknowledgment from all staff. Guardian background check system revealed that S1 was separated from the facility roster on 01/04/2026. Personnel report - LIC 500 dated 01/06/2026 does not list S1. No deficiencies were cited at this time. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Jan 12, 2026

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility at 1:20 p.m. to conduct an unannounced continuation of the annual inspection that began on November 5, 2025 (11/05/2025). Upon arrival LPA was greeted by Assistant Administrator / Designee and explained the reason for the visit. The LPA met with Assistant Administrator, Magdalena Garcia and Administrator Designee, Marisol Flamenco and reason for the visit was explained.Entrance interview. During the annual inspection that was conducted on 11/5/2025 LPA Mosley conducted the full physical plant tour in which LPA observed the common areas, bedrooms, restrooms, kitchen, backyard, garage and conducted staff and resident interviews and obtained pertinent documentation. During today’s visit, starting at 1:22 p.m. LPA conducted the entrance interview and a brief physical plant tour to ensure there are no immediate health and safety concerns, and facility is in compliance with Title 22 Regulations. The following was noted: The facility is a single-story residential home with an attached garage. Six (6) private resident rooms, and two (2) restrooms. There is no staff room and Administrator stated that staff remain awake at night. The facility is fire cleared for six (6) non-ambulatory residents of which one (1) may be bedridden and a hospice waiver for five (5). During the visit LPA observed a music class where residents were actively participating. Activities observed. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... RECORDS:Resident Records: were reviewed beginning at 1:43 p.m. six (6) 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. Personnel Records were reviewed beginning at 2:59 p.m. five (5) 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 3:26 p.m. Medications are centrally stored and locked in a medication cart located in the kitchen adjacent garage entrance. Medications for three (3) 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: LPA obtained the following documents during initial visit on 11/5/2025 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, Nov 6, 2025

Allegation investigated: Staff does not ensure resident does not sustain pressure injuries. Staff does not ensure resident's bathroom needs are being met. Staff left resident on floor for an extended period of time. Staff does not ensure resident is provided adequate food service. Staff is mismanaging resident's medications.

Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above listed allegations. Upon arrival approx. at 10 a.m., LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. At 10:22 a.m. LPA met with Designee Marisol Flamenco and Magdalena Garcia, Assistant Administrator and the reason for the visit was explained. Entrance interview conducted. On 11/02/2025, the Department received a complaint regarding the following allegations, Staff does not ensure resident does not sustain pressure injuries, Staff does not ensure resident's bathroom needs are being met, Staff left resident on floor for an extended period of time, Staff does not ensure resident is provided adequate food service, Staff is mismanaging resident's medications. During today's visit starting at 10:06 a.m. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. Report continued on LIC 9099-C PAGE 2... Unsubstantiated (PAGE 2) Report continued from LIC 9099... Starting at 10:29 a.m. LPA conducted in person interviews with the four (4) staff including the Designee and Assistant Administrator, two (2) residents including Resident #1 (R1), a telephonic interview with the Power of Attorney (POA) of R1, a record review, medication review and audit and obtained copies of pertinent documents relevant to the investigation. On the allegation Staff does not ensure resident does not sustain pressure injuries, it is the concern of the Reporting Party (RP) that R1 was observed to have bed sores. To investigate this complaint, LPA Mosley conducted interviews with four (4) staff, two (2) residents including R1, a telephonic interview with the POA of R1, a record review and obtained copies of pertinent documents relevant to the investigation. Interviews with staff revealed that R1 has been on hospice care since 10/29/2025. R1 does not have any bed sores. However, R1 has a wound on their right ankle that originated as a pimple and was frequently scratched by R1, resulting in an open wound. R1 is seen by their hospice nurse two (2) times per week and by a wound care specialist two (2) times per week, during which the wound is treated. Interview with R1 revealed that they have had a metal plate in their right ankle for many years. They developed a pimple-like bump on the ankle, which they repeatedly scratched, leading to an exposed wound. R1 is currently seen by a nurse three (3) to four (4) times per week for wound care. R1 confirmed that they do not have any pressure injuries. Interview with the POA confirmed that R1 does not have any pressure injuries. The POA stated that R1 has a metal plate in their ankle and developed a pimple-like bump, which R1 scratched open, leaving it exposed. As of 10/29/2025, R1 has been on hospice care and receiving wound treatment for the injury. R1 has not sustained any pressure injuries while at the facility. Record review confirmed that R1 has been on hospice care since 10/29/2025 and is seen by a wound care specialist two (2) times per week. Wound care is documented in R1’s care plan. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff does not ensure resident does not sustain pressure injuries is deemed unsubstantiated at this time. On the allegation Staff does not ensure resident's bathroom needs are being met it is the concern of the Reporting Party (RP) that R1 needed to use the bathroom and staff did not assist. To investigate this complaint, LPA Mosley conducted interviews with four (4) staff, two (2) residents including R1, a telephonic interview with the POA of R1, a record review and obtained copies of pertinent documents relevant to the investigation. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC 9099-C PAGE 2...Staff interviews revealed that they assist all residents with using the bathroom at a minimum of every two (2) hours. After each meal, staff escort residents to the bathroom and encourage them to try. R1 has the capacity to request bathroom assistance and frequently does so. When R1 asks to use the bathroom, staff respond and assist as promptly as possible. Staff consistently assist residents with their bathroom needs.Interviews with R1 revealed that they have not experienced any issues with staff assistance regarding bathroom use. R1 stated they would not allow such issues to occur and confirmed that their bathroom needs are being met. R1 affirmed that staff have always assisted them whenever needed. Interview with Resident #2 (R2) revealed that they have not encountered any concerns with staff assistance for bathroom use. R2 also stated that they have never observed any other residents experiencing issues with bathroom assistance. Interview with the POA revealed that they have been involved with the facility for several years and have not had any issues or concerns. They expressed satisfaction with the care being provided and confirmed they have not witnessed any concerns related to staff assistance with bathroom use. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff does not ensure resident's bathroom needs are being met is deemed unsubstantiated at this time. On the allegation Staff left resident on floor for an extended period of time it is the concern of the Reporting Party (RP) that a resident slid out of their wheelchair and staff were unable to help get them up. To investigate this complaint, LPA Mosley conducted interviews with four (4) staff, two (2) residents including R1, a telephonic interview with the POA of R1, a record review and obtained copies of pertinent documents relevant to the investigation. Interviews with staff revealed that the facility typically schedules two (2) staff members during the morning and evening shifts, and one (1) staff member during the night shift. Staff reported that no residents have recently slid out of their wheelchairs. In the event that a resident were to slide out of their wheelchair, staff would respond promptly. Staff emphasized that residents are not left on the floor for an extended period of time.Interviews with residents revealed that they have not witnessed any resident slide out of their wheelchair. They also stated they have not observed any resident left on the floor for an extended period of time. Residents confirmed that staff are prompt in providing assistance and expressed no concerns regarding staff response times.Interview with the POA revealed that they have not witnessed any resident left on the floor for an extended period of time. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff left resident on floor for an extended period of time is deemed unsubstantiated at this time. Report continued on LIC 9099-C PAGE 4... (PAGE 4) Report continued from LIC 9099-C PAGE 3... On the allegation Staff does not ensure resident is provided adequate food service it is the concern of the Reporting Party (RP) that R1 seemed very hungry while the facility and tells the family that R1 does not eat. To investigate this complaint, LPA Mosley conducted interviews with four (4) staff, two (2) residents including R1, a telephonic interview with the POA of R1, a record review and obtained copies of pertinent documents relevant to the investigation. Interviews with staff revealed that R1 is a particular eater and enjoys restaurant food. R1 consumes small portions. Staff encourage R1 to eat as much as possible but respect that R1 has a limited appetite. At times, R1’s family will order DoorDash meals for R1, as they prefer restaurant food. R1 typically eats only a small amount of the ordered food, leaving leftovers that are offered again later in the day. Interviews with R1 revealed that they are a picky eater and enjoy restaurant food. While the facility provides good-quality meals, R1 prefers restaurant options. R1 is consistently provided with nutritious meals. If R1 feels hungry, the facility offers additional food or snacks. R1 reported no issues with food availability or access. Interview with the POA confirmed that R1 receives nutritious meals at the facility. R1 enjoys restaurant food, and staff make every effort to encourage R1 to eat. The POA expressed no concerns regarding the meals provided to R1. They acknowledged that R1’s appetite has declined over the past couple of years, but noted that the facility continues to make efforts to support R1’s nutritional needs. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff does not ensure resident is provided adequate food service is deemed unsubstantiated at this time. On the allegation Staff is mismanaging resident's medications it is the concern of the Reporting Party (RP) that R1 has medication that must be refrigerated and was left out on the counter. To investigate this complaint, LPA Mosley conducted interviews with four (4) staff, two (2) residents including R1, a telephonic interview with the POA of R1, a record review, medication review and audit and obtained copies of pertinent documents relevant to the investigation. Staff interviews revealed that they follow all residents’ medication directions and instructions. Currently, there are no residents receiving medications that require refrigeration. Staff state that medications are not left accessible. Interviews with R1 revealed that they are aware of the medications they are taking, none of which require refrigeration. R1 reported no issues with their medications. Interview with the POA confirmed that R1 is not prescribed any medications requiring refrigeration. Report continued on LIC 9099-C PAGE 5... (PAGE 5) Report continued from LIC 9099-C PAGE 4... The POA stated they have no concerns regarding R1’s medication management. Record review indicated that R1 does not have any medications requiring refrigeration. Medication audit showed that R1’s medications are properly labeled and checked for expiration dates. All medications, including PRNs, were appropriately labeled, securely stored, and locked, making them inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and accurately documented on the centrally stored medication and destruction records. No errors were observed during the review.Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff is mismanaging resident's medications is deemed unsubstantiated at this time. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Nov 5, 2025 · control 29-AS-20251102170630

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 10 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator Designee, Marisol Flamenco and Magdalena Garcia, Assistant Administrator arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and staff 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 3:58 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 07/17/2025. 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. Activities were observed in the common areas. The fireplace in the living room was adequately screened. 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 10:29 a.m. four (4) staff and two (2) resident interviews were conducted. Staff interviews revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews 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 six (6) total bedrooms in the facility; All six (6) bedrooms are designated as private, single occupancy, resident rooms. Two (2) 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. The facility does not have a staff room and the staff remain awake at night. RESTROOMS: There are two (2) total restrooms. Both are designated as a shared / common resident restrooms. 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 105.6-116.1 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed to be in the garage in a locked cabinet. 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 118.6 degrees Fahrenheit within the required range. Cleaning supplies and other chemicals are kept in the garage locked and inaccessible to residents in care. BACKYARD: The entire property is fenced. The backyard has a covered patio area with 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. Only one (1) pathway is used as an emergency exit which was free of obstructions at the time of the visit. GARAGE: LPA observed the facility garage, which was locked and contained emergency food and water, emergency supplies, an extra refrigerator/freezer that were checked for proper labels and expiration dates. Due to time constraints the LPA will return to complete the annual at a later date. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Nov 5, 2025

Allegation investigated: Medication is not being administered as prescribed.

Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced subsequent complaint visit. The LPA met with staff and explained the reason for the visit. Administrator Debra Bryant approxiamtely arrived at 4:00 p.m. The facility was under a red flag warning during today's visit. On 01/10/2024, the Department received a complaint regarding the following allegation, Medication is not being administered as prescribed. On 01/17/2024, LPA Campos, interviewed staff at 12:33 p.m. and 12:38 p.m. and the administrator at 12:50 p.m. reviewed and collected pertinent documents at 2:00 p.m. The LPA determined further investigation was required prior to issuing findings. During today's visit on 01/13/2025, LPA Cortez conducted a medication audit at 11:40 a.m., interviewed the administrator, three (3) staff and one (1) resident starting at 1:00 p.m., conducted a brief tour of the home at 2:35 p.m., and conducted a file review at 4:00 p.m. Report will continue on LIC9099-C, 2nd page. Unsubstantiated On the allegation that the “Medication is not being administered as prescribed”, it is the concern of the reporting party (RP) that a former staff member (S1) had been stealing Norco medication from residents and administering Tylenol instead. It was further reported that after Resident 1's (R1's) passing on 12/30/2023, it was discovered their Norco medication was missing, and S1 was suspected of taking it. To investigate the allegation, LPA Campos and Cortez interviewed staff and LPA Cortez conducted a medication audit for all five (5) residents and a file review for R1. Staff interviews revealed that they have not witness or suspected any staff stealing or mishandling residents medications, do not have any concerns of residents not being administered their prescribed medications, and that S1 no longer works at this facility. Resident interviewed did not voice any concerns. At 11:40 a,m, the LPA conducted a medication audit and reviewed the Centrally Stored Medication and Destruction Record (CSMDR), along with the medications in their bubble packs/bottles for the month of January of this year. Medication audit revealed each resident was administered their medications as prescribed from 1/1/2024 to present, at this time. File Review revealed that R1's Norco medication was discontinued on 12/11/2023. Based on interviews conducted, medication audit, and file review although the allegation may have happened or is valid, the department does not have sufficient evidence to determine that Medication is not being administered as prescribed. Therefore, the above allegation is deemed UNSUBSTANTIATED at this time Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Jan 13, 2025 · control 29-AS-20240110165920

Type of visit: Case Management - Deficiencies

On 1/13/2025, Licensing Program Analyst (LPA) Esther Cortez conducted a case management-deficiencies visit in conjunction with the complaint investigation conducted today for a complaint received on 1/10/2024. The purpose of this Case Management is to address the deficiency observed during the course of the complaint investigation. LPA discuss todays observation to Debra Bryant, licensee who came about at 4:00 p.m. The facility was under a red flag warning during today's visit. The following was observed during today's visit while conducting a file audit - The staff were not able to provide the destruction records for Resident 1's (R1's) Norco medication that was discontinued on 12/11/2023. Deficiency issued during this visit today. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Jan 13, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(i) · Plan of correction due date: Jan 24, 2025

87465(i) Prescription medications which are not taken with the resident upon termination of services,......shall be destroyed in the facility ... to be retained for at least three years, which lists the following:...This requirement is not met as evidenced by: Based on file review and interviews, the licensee did not comply with the section cited above as they did not have a destruction record for R1's Norco which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 13, 2025

Plan of correction: Administrator agress that by 09/17/24 they will submit a statement of understanding that they reviewed the regulation and will document when medications are centrally destroyed.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 02:25PM. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Designee Marisol Flamenco arrived shortly thereafter. Entrance interview conducted. RECORDS: Records review began at 02:34PM. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. 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. MEDICATIONS: Medications review began at 02:55PM; medications are centrally stored and locked in a medicine cart in the kitchen. Medications are labeled and checked for expiration dates. Medications for 2 (two) residents were observed. Both residents' medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility has an infection control plan and emergency disaster plan; both of which were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill documented on 08/13/2024. Beginning at 03:11PM, the LPA and Administrator Designee 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. The following was observed: Fire extinguisher was observed to be fully charged and Administrator Designee stated was recently purchased, around the time of LPA Chochian's last visit. LPA Dulek advised Designee to retain proof of purchase date. All combination smoke and carbon monoxide detectors were functional during testing. Report continued LIC 809-C BEDROOMS: The facility has 6 (six) private residents' bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The facility does not have a staff room. RESTROOMS: There are 2 (two) common restrooms for residents' use, both were clean and sanitary and in operating condition with hand soap and paper towels. The hot water temperature tested in the common bathrooms within the approved limits. COMMON SPACES: Living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which was observed to be screened and inaccessible to residents in care. Auditory devices on exit doors were observed and functioning. There was a linen closet in the hallway with extra towels and linens, as well as a closet containing activity supplies. KITCHEN/GARAGE: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Medications are stored in a locked medicine cart in the kitchen. The garage was observed adjacent to the kitchen. The garage contains locked storage for knives and other sharps. There are also separate storage areas for food, hygiene items and cleaning supplies, as well as laundry area, emergency food and water. The garage is locked and inaccessible. OUTDOOR AREA: The backyard patio is equipped with furniture for residents' use. There is a side gate for resident use and is single-latched. No bodies of water were noted. All passageways were noted to be clear and free of hazards. The LPA reviewed the following documents: - LIC9020 Client Roster - Liability Insurance No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 23, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA met with Administrator Chrissy Cortez and explained the reason for the visit. The LPA and the 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. KITCHEN: Knives and cleaning supplies are stored in locked cabinets. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Medications are stored in a locked medicine cart in the kitchen. BEDROOMS: The facility has six private residents' bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The facility does not have a staff room. RESTROOMS: There are two common restrooms for residents' use, both were clean and sanitary and in operating condition with hand soap and paper towels. The hot water temperature tested in the common bathrooms within the approved limits. COMMON SPACES: Living room and dining room furniture was observed to be in good condition. Auditory devices observed were functioning. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher was fully charged and purchased within the last year on 05/23/2023. There was a linen closet in the hallway with extra towels and linens. Report continued LIC 809-C. OUTDOOR/GARAGE AREA: The backyard patio is equipped with furniture for residents' use. There is a side gate for client use and is single-latched. No bodies of water were noted. Washer and dryer are in the garage area and were observed to be in operable condition. An additional refrigerator and freezer with perishable food items was observed in the garage. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. The garage is locked and inaccessible. RECORDS: Records review began at 1:25 p.m., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. 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. MEDICATIONS: Medications review began at 2:15 p.m.; medications are centrally stored and locked in a Medications are stored in a locked medicine cart in the kitchen. ; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. 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 LPA reviewed the following documents: - LIC500 Personnel Report - 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, Nov 16, 2023