Humble Haven RCFE V

Type of visit: Required - 1 Year

On 4/09/2025, Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit and was greeted by two staff members. The Administrator, Nicole De Las Alas was called by the staff member. LPA stated the purpose of the visit was to conduct an annual inspection. The staff members confirmed there are four residents. The facility is licensed for five (5) non-ambulatory and one (1) bedridden resident. LPA and the staff member toured the facility at 10:15 am until 10:45 am. Common Areas – The living room contained comfortable seating. The family room, dining room, and kitchen are combined. The family room was furnished with comfortable seating and a television. The dining room area contained a dining room table and chairs. Kitchen - LPA Spaeth observed a two-day supply of perishable food and a seven day supply of non-perishable food. The knives were securely locked in a kitchen cabinet. The cleaning solutions were locked underneath the kitchen sink. The fire extinguisher is located in the kitchen and is operable. The medications were locked in a kitchen cabinet along with the first aid kit. Continued on 809-C Resident Rooms: There are four resident rooms which were furnished with a bed, linens, night stand, lamp and chair. The rooms were neat and clean. Laundry Room: The laundry room was locked and contained laundry soap, washer and dryer. Bathrooms: There are three (3) bathrooms which contained hand soap, paper towels, grab bars, trash can, and slip resistant mats. Water Temperature: The water temperature was tested at 10:30 am and was 108.4 Degrees F. Additional Hallway Closet - LPA observed the clean linens were located in a closet and another locked closet contained the hygiene items. Staff Room: The staff room was locked. Smoke/Carbon Monoxide Detectors: The smoke/carbon monoxide detectors were tested at 11:00 am and were operable. LPA Spaeth reviewed the resident files at 11:10 am until 11:51 am. LPA reviewed staff files at 11:55 am until 12:30 pm. LPA reviewed the medications at 1:00 pm until 1:20 pm. Based upon Title 22 Regulations, the following deficiencies are substantiated. (See 809-D page). Exit interview conducted, appeal rights discussed, and a copy of the signed report was given.the state’s words, verbatim · CDSS document, Apr 9, 2025

Type of visit: Required - 1 Year

On 4/11/2024, Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit and was greeted by two staff members. The Administrator, Nicole De Las Alas was called by the staff member. LPA stated the purpose of the visit was to conduct an annual inspection. The staff members confirmed there are six residents. The facility is licensed for five (5) non-ambulatory and one (1) bedridden resident. LPA and the staff member toured the facility at 10:30 am until 11:00 am. Common Areas – The living room contained comfortable furniture. The family room, dining room, and kitchen are combined. The family room was furnished with comfortable seating and a television. The dining room area contained a dining room table and chairs. Kitchen - LPA Spaeth observed a two-day supply of perishable food and a seven day supply of non-perishable food. The knives were securely locked in a kitchen cabinet. The cleaning solutions were locked underneath the kitchen sink. The fire extinguisher is located in the kitchen and is operable. The medications were locked in a kitchen cabinet along with the first aid kit. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. The side gate was closed and was not locked. Comfortable seating is also located in the backyard. The hot tub did not contain water and was properly covered. Garage – The garage was locked and was organized. Continued on 809-C Resident Rooms: There are four resident rooms which were furnished with a bed, linens, night stand, lamp and chair. The rooms were neat and clean. Laundry Room: The laundry room was locked Bathrooms: There are three (3) bathrooms which contained hand soap, paper towels, grab bars, trash can, and slip resistant mats. The water temperature was recorded to be 121.4 Degrees F at 10:50 am Additional Hallway Closet - LPA observed the clean linens were located in a closet and another locked closet contained the hygiene items. Staff Room: The staff room was locked. Smoke/Carbon Monoxide Detectors: The smoke/carbon monoxide detectors were tested at 11:00 am and were operable. LPA Spaeth reviewed the resident files at 11:10 am until 11:51 am. LPA reviewed staff files at 12:20 pm until 1:00 pm. LPA reviewed the medications at 1:00 pm until 1:20 pm. Based upon Title 22 Regulations, the following deficiency is substantiated. (See 809-D page). Exit interview conducted, appeal rights discussed, and a copy of the signed report was given.the state’s words, verbatim · CDSS document, Apr 11, 2024