Land of Enchantment 1 Board and Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:15 A.M. Upon arrival, LPA Conway was greeted by staff Markdel Estrada who called the Administrator to inform them of the visit. The Administrator, Roxana Lara arrived shortly after and the reason for the visit was explained. 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: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a temperature of 77 degrees Fahrenheit. At 11:13 A.M., hardwire combination of smoke/carbon monoxide detector and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 06/27/2026. The emergency telephone numbers are posted in common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 07/05/2026 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. LPA observed a locked storage closet adjacent to the entrance with an adequate amount of emergency supplies. There is a functioning telephone on the premises. The LPA observed cameras in all common spaces and exterior. LPA observed that one resident was using supplemental oxygen; however, "No Smoking – Oxygen in Use" signage was not present in areas where oxygen was in use. Technical Violation (TV) issued. Administrator immediately posted signs in the appropriate locations throughout the facility. Continued on LIC 809-C Continued from LIC 809 BEDROOMS: There are seven (7) total bedrooms in the facility; of which six (6) bedrooms are designated as private single occupancy, resident rooms and one (1) staff room. The staff room is kept locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS: There are three (3) bathrooms. Two (2) are designated as shared/common bathroom, one (1) is designated as a private resident bathroom in Room #2. Resident bathrooms were observed to be equipped with a slip-resistant surfaces and grab bars. The restrooms were sufficiently stocked with supplies and paper towels. The water temperature was measured in all restrooms and ranged between 107.2 - 109.6 degrees Fahrenheit, all within the required range. GARAGE: The entry to the garage was observed to be locked and inaccessible to residents. The garage was observed to contain a washer and dryer, laundry supplies and chemicals and various cleaning supplies. Garage contained adequate emergency water supplies. LPA observed an extra refrigerator with food that was checked for proper labels and expiration dates. KITCHEN: The LPA inspected the kitchen/food service area at 10:10 A.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 108.3 degrees Fahrenheit at 10:13 A.M. Cleaning supplies and other chemicals are kept in a locked cabinet inaccessible to residents in care. Continued on LIC 809-C Continued from LIC 809-C OUTDOOR SPACE: The backyard has sufficient patio furniture including shaded tables and chairs for resident use. One outdoor shed was observed to contain extra care supplies. Facility has two exit gates that were observed to self-latch, LPA observed clear passageways for emergency exit use. There were no bodies of water on the premises. RECORDS: Record review began at approx. 10:52 A.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. Six (6) 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 LPA Conway reviewed the facility’s infection control practices and emergency disaster plan. The facilities policies and procedures as they pertain to infection control and emergency preparedness are satisfactory, however, they were last reviewed/updated more than 12 months ago. Technical Violation (TV) issued. MEDICATIONS: Medications review began at approximately 1:15 p.m. The medications are in a locked cabinet area adjacent to the kitchen. Medications for three (3) of five (5) 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 two complete first aid kits, one located in the kitchen and the other one located in the medication cabinet. The following documents were obtained during today’s visit: Personnel Report (LIC 500), Register of Facility Residents (LIC 9020), and current Liability Insurance. LPA observed that the facility sketch on file did not accurately reflect the current layout of the facility. LPA requested an updated sketch to be submitted to the Department. No citations issued. Exit interview conducted. Copy of the report providedthe state’s words, verbatim · CDSS document, Jul 9, 2026

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 10:15 a.m. Upon arrival, LPA Mosley was greeted by staff / house manager Tiffany Lara who called the Administrator to inform them of the visit. The Administrator, Roxana Lara arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and house manager 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: 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 12:36 p.m., hardwire combination of smoke / carbon monoxide detector and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 07/09/2025. The emergency telephone numbers are posted in common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 06/20/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. LPA observed a locked storage closet adjacent to the entrance with an adequate amount of emergency supplies. There is a functioning telephone on the premises. BEDROOMS: There are seven (7) total bedrooms in the facility; of which six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff room is kept locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809... RESTROOMS: There are three (3) restrooms. One (1) is designated as shared / common bathroom, one (1) is designated as a private resident bathroom and one (1) is designated as a staff bathroom. Resident restrooms were observed to be equipped with a slip-resistant surface. Grab bars were observed in the bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The water temperature was measured all resident restrooms and ranged between 105.1 -105.6 degrees Fahrenheit, all within the required range. GARAGE: The entry to the garage was observed to be locked and inaccessible to residents. The garage was observed to contain a washer and dryer, laundry supplies and chemicals are stored in the garage along with various cleaning supplies. Garage contained adequate emergency food and water supplies. LPA observed an extra refrigerator with food that was checked for proper labels and expiration dates. KITCHEN: The LPA inspected the kitchen/food service area at 10:28 a.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 106.1 degrees Fahrenheit at 10:30 a.m. Cleaning supplies and other chemicals are kept in a locked cabinet inaccessible to residents in care. OUTDOOR SPACE: The backyard has sufficient patio furniture including shaded tables and chairs for resident use. One outdoor shed was observed to contain extra care supplies. Facility has two exit gates that were observed to self-latch, LPA observed clear passageways for emergency exit use. RECORDS: Record review began at approx. 10:49 a.m. Resident Records were reviewed beginning at 10:51 a.m. and Personnel Records at 11:52 a.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. Six (6) 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. Report Continued from LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit LPA Mosley reviewed the facility’s infection control practices and emergency disaster plan. The facilities policies and procedures as they pertain to infection control and emergency preparedness are satisfactory. INTERVIEWS: Throughout the visit, starting at 10:40 a.m one (1) staff and three (3) resident interviews were conducted. Staff interview 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. MEDICATIONS: Medications review began at approximately 1:15 p.m. The medications are in a locked cabinet area adjacent to the kitchen. Medications for three (3) of five (5) 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. Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, and current Liability Insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of the report provided.the state’s words, verbatim · CDSS document, Jul 10, 2025

Allegation investigated: Staff engaged in inappropriate interactions with an adult on the premises in the presence of a resident. Staff did not provide a comfortable environment for residents. Staff did not ensure that residents had appropriate furniture. Illegal eviction.

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to investigate the allegations listed above. LPA Urena met with the Manager Tiffany Lara and explained the reason for the visit. The licensee Roxana Lara arrived shortly thereafter. The LPA and the Manager conducted a tour of the facility to ensure there are no health or safety concerns. LPA Urena interviewed the Licesee and staff at 10:55 a.m. On 03/22/2024, Licensing Program Analysts (LPAs) Brittany Thomas and Martha Arroyo conducted an unannounced initial complaint investigation for the allegations listed above. LPAs toured the facility to ensure there are no health or safety concerns. At 11:14 a.m., LPAs conducted an interview with the Administrator, three staff members, and three residents between 10:52 a.m. and 12:45 p.m., conducted a resident’s file review at 12:10 p.m., and obtained copies of pertinent documents relevant to the investigation. Continues on LIC 9099C... Unsubstantiated Staff engaged in inappropriate interactions with an adult on the premises in the presence of a resident. On the allegation of inappropriate interactions by staff, the concern of the reporting party is that while the RP was talking to with the Licensee in the backyard regarding some concerns, a facility staff (S1) intervened in the discussion. S1 came very close to the RP’s face. The incident occurred very close to one of the residents’ rooms, and another resident was sitting in the dining room. On 03/22/2024, LPAs Arroyo and Thomas interviewed S1, and S1 stated that the RP does not allow personal space for staff: RP answers the facility phone, goes into the kitchen while staff are preparing meals, and goes into other residents’ rooms. Furthermore, the LPAs interviewed residents and their representatives, and the interviews revealed that residents and their representatives are satisfied with the facility staff and had no concerns. On 03/13/2025, LPA Urena interviewed the Licensee and S1 about engaging in inappropriate behavior towards any of residents or any visitor to the facility, and S1 denied being disrespectful or displaying inappropriate behavior. to anyone at the facility. The Licensee denied that the staff engaged in inappropriate interaction with others at the facility. Based on the information obtained through interviews; although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time. Staff did not provide a comfortable environment for residents. On the allegation that staff does not provide a comfortable environment, it is the concern of the RP that they observed two broken recliners in the living room. On 03/22/2024, at 11:14 a.m. Licensing Program Analysts (LPAs) Brittany Thomas and Martha Arroyo along with the Licensee conducted a tour of the facility to ensure there were no health or safety concerns. At the time of the visit, the LPAs did not observe any concerns. Furthermore, the LPAs conducted residents’ interviews, and responsible parties’ interviews. All interviews (residents’ and responsible parties’) revealed that they were happy with the facility and staff, and did not have any concerns or issues. The RP stated that they had noticed some broken chairs in the common area. On 03/13/2025, LPA Urena interviewed the Licensee and S1, and they denied having any broken recliners. Based on the observations, and information obtained through interviews, the facility has appropriate furniture for residents in care. Therefore, the allegation is deemed Unsubstantiated at this time. Amended report to correct formatting. Staff did not ensure that residents had appropriate furniture. On the allegation that staff did not ensure residents have appropriate furniture, the RP’s concern is that they observed that a resident’s bed was broken, and that the staff did not inform the resident’s next of kin about it. On 03/22/2024, at 11:14 a.m. Licensing Program Analysts (LPAs) Brittany Thomas and Martha Arroyo along with the Administrator conducted a tour of the facility to ensure there were no health or safety concerns. At the time of the visit, the LPAs did not observe any concerns, and furniture appeared in good condition throughout the facility. Furthermore, the LPAs conducted residents’ interviews, and responsible parties’ interviews. All interviews (residents’ and responsible parties’) revealed that they were happy with the facility and facility staff, and did not have any concerns or issues. On 03/13/2025, LPA Urena interviewed the Licensee and S1, and they stated that they were not aware of resident's bed broken. Based on the observations, and information obtained through interviews, the facility has appropriate furniture for residents in care. Therefore, the allegation is deemed Unsubstantiated at this time. Illegal eviction. On the allegation of illegal eviction, the RP’s concern is that the Licensee threaten to evict R1 as retaliation due to the RP bringing their concerns to the Licensee about a facility staff. On 04/04/2024, during an interview via telephone with Licensing Program Manager (LPM) Kasandra Lopez, the RP stated that the Administrator did not give R1 a written eviction notice; but gave R1’s representative a verbal warning that R1 could be evicted due to the “representative raising their voice to staff.” On 03/13/2025, LPA Urena interviewed the Licensee about the eviction threat, and the Administrator denied making such threats. Furthermore the Licensee provided a letter from the R1's representative that they were giving the facility the 30 day notice to vacate the facility on their own accord. Although the allegation may have happened or is valid, based on the interviews, there is not sufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. No citations were issued at this time. Exit interview was conducted and a copy of the report was issued. Edit History Edit Historythe state’s words, verbatim · CDSS document, Mar 13, 2025 · control 29-AS-20240321154046

Allegation investigated: Staff did not communicate with resident's responsible party in a timely manner. Staff do not allow resident's responsible party to feed resident in care.

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to investigate the allegations listed above. LPA Urena met with the Manager Tiffany Lara and explained the reason for the visit. The Licensee Roxana Lara arrived shortly thereafter. The LPA and the Manager conducted a tour of the facility to ensure there are no health or safety concerns. LPA Urena interviewed the licesee and staff at 10:55 a.m. On 04/02/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced complaint initial visit to investigate the allegations listed above. The LPA met with facility Manager Tiffany Lara at 11:40 a.m. and explained the reason for the visit. The manager called the licensee on the phone and allowed the LPA to explain the reason of the visit and interviewed the licensee on the phone. At 1:15 p.m. the LPA requested documents pertaining to the investigation and interviewed the manager and caregiver staff. Continues on LIC9099C... Unsubstantiated Staff did not communicate with resident's responsible party in a timely manner. On the allegation that staff did not communicate in a timely manner, the concern of the RP is that they requested photographs taken by facility staff of R1 of a specific event, and as of 03/28/2024 the facility staff had not provided the photos to the RP. To investigate the allegation the LPA interviewed the staff and the licensee about the photos taken by S1 during a time when R1 was being changed by staff (S1). The interviews revealed that the process of taking the pictures of R1 was done in four (4) steps as requested by the RP. The pictures were taken accordingly except for step three (3) when the staff got distracted by the RP, and was unable to get the third picture and S1 explained to the RP why they didn’t take the picture. Furthermore, S1 stated that the RP was taking pictures at the same time as S1. Base on the information obtained through interviews; although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time. Staff do not allow resident's responsible party to feed resident in care. On the allegation that staff are not allowing the responsible party to feed R1, it is the concern of the Reporting Party that the responsible party has been told not to feed R1. The LPA interviewed the Licensee and S1 about preventing the responsible party to feed R1. The LIcensee and staff stated, “We have never told the responsible party not to feed R1, the responsible can if they want to come during the mealtimes. Furthermore, the Licensee and S1 stated that during one occasion the RP asked R1 who they prefer to be fed by, and R1 pointed to the staff. Base on the information obtained through interviews; although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time. No citations were issued at this time. Exit interview was conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 13, 2025 · control 29-AS-20240328125225

Allegation investigated: Staff did not properly manage resident's medication. Staff did not safeguard resident's personal belongings.

Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to deliver finding regaring above noted allegations. LPA initially met with staff who called the administrator. LPA spoke with administrator and explained the reason for the visit. On 07/31/2024, Community Care Licensing Division (CCLD) received the above listed allegations. Inital complaint visit was conducted on 08/07/2024. Interview was conducted with staff and residents. Also resident records were reviewed. Following is a summuary of the allegations and investigation finding. Regarding allegation "Staff did not properly manage resident's medication": Information was reported that facility staff documented the wrong dose of resident #1's Metformin medication. During the intial complaint visit and today's visit former resident's (R1) records including but not limited to R1's medication records were reviewed and discussion was held with Administrator. (Continue to LIC9099c) Unsubstantiated According to Administrator the medication release list dated 7/28/2024 did have a typo (metformin 50mg) however the centrally stored medication record used by facility which documents all medications that R1 was provided as prescribed is correct and accurate. LPA reviewed the centrally stored record for R1 and observed no descripencies. According to administrator and staff R1 was receiving the correct dose of metformin (500mg) and the medication was correctly documented on the centrally stored records from (move-in to move-out) 5/2020-7/2024. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation "Staff did not properly manage resident's medication" is deemed UNSUBSTANTIATED at this time. Regarding allegation "Staff did not safeguard resident's personal belongings": Information was reported that the R1's clothes were ruined while living at the facility. Several attempts were made (8/16/2024; 9/25/2024;10/23/24) to gather additional information regarding this allegation however no furnter information was provided during the course of the investigation from the reporting party. Investigation was initiated on 08/07/2024 and interview was conducted with staff and records were reviewed. According to administrator and staff R1's clothing was not ruined by any staff. Administrator stated that R1 had one pants which tore from the waist and administrator had it fixed; a zipper came off from one of R1's jacket and that was taken by family to fix. According to administrator all belongings that were itimized on the Client/Resident Personal Property and Valuables form (LIC621) dated 4/23/2024 were provided to R1's family. Records reviewed revealed that R1's LIC621 prepared and signed by responsible person on 4/25/2022 and 4/23/2024 did not include any of R1's clothing. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation "Staff did not safeguard resident's personal belongings" is deemed UNSUBSTANTIATED at this time. Exit interview held. Copy of report provided.the state’s words, verbatim · CDSS document, Nov 18, 2024 · control 29-AS-20240731145531

Allegation investigated: Facility staff are not following doctor's orders in regards to the resident's use of compression socks. Facility staff are not following doctor's orders in regards to the resident needing to be out of bed during the day. Family member was not allowed access to resident records

Licensing Program Analyst (LPA) Zabel Chochian conducted an initial complaint visit regarding the above noted allegations. LPA met with administrator and the reason for the visit was explained. On 06/20/20224, Community Care Licensing Division (CCLD) received a complaint with the above allegations. Investigation was initiated by LPA Teresa Camara on 06/26/2024. LPA Camara conducted an initial complaint investigation visit regarding the above noted allegations. LPA initially met with staff who called the administrator. The administrator arrived at 9:50 a.m. and LPA explained the reason for the visit. LPA conducted a brief tour inside the facility at 9:46 a.m. with staff. LPA conducted an interview with administrator starting at 9:50 a.m. LPA reviewed and obtained pertinent records starting at 10:15 a.m. On 08/07/2024, LPA Chochian conducted additional interviews with staff, residents and reviewed records pertinent to this case between 11:32am-2:15pm. Unsubstantiated Following is a summary of the investigation findings: Regarding allegation, “Facility staff are not following doctor's orders in regard to the resident's use of compression socks” – It was alleged that staff refuse to put resident #1’s “compression socks”. Interview with facility administrator and staff revealed that R1’s compression socks were used daily throughout the day and when R1’s family would visit they would take them off. Records reviewed revealed that the order for the compression socks was for anytime resident is out of bed. Administrator and staff stated that R1 would have the compression socks on anytime R1 was out of bed and during outings. Staff and administrator expressed that the compression socks were tight so eventually it caused skin tear to R1’s legs. Administrator stated that she contacted the doctor however never received a response back. According to administrator and staff when R1’s legs were elevated they would not put the compression socks because it was causing skin redness and tear. Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Facility staff are not following doctor's orders in regard to the resident's use of compression socks” is deemed UNSUBSTANTIATED at this time. Regarding allegation, “Facility staff are not following doctor's orders in regard to the resident needing to be out of bed during the day” – Information was provided that R1 is to be in the living room, in recliner during the day as ordered by the physician. Staff and administrator stated that R1 was responsive and would request to stay in be and not be transferred with the hoyer lift. However, R1’s family obtained an order for R1 to be out of bed during the day. Administrator stated that R1 was transferred to the dining table for each meal every day; R1 was out of bed for meals; and in the recliner in the living room watching television. Interview with staff and administrator revealed that R1 was out of bed during the day as ordered by the doctor and would only be in the room if resident requested not to be transferred. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Facility staff did not note changes in resident's medical condition” is deemed UNSUBSTANTIATED at this time. Regarding allegation, “Family member was not allowed access to resident records” – Information was provided that Administrator did not allow family member access to R1’s records when requested (date unknown). Interview with administrator and staff revealed that R1’s family was allowed access to R1’s records. (Continue to LIC 9099c) Administrator stated that the family of R1 was at the facility on a weekend and requested records however administrator was not at the facility and therefore could not provide the records. Administrator stated that she informed the family that they may review the records on Monday. Administrator confirmed that the family was provided the records within one day. Based on the above information gathered although the allegations may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the above allegation “Family member was not allowed access to resident records” is deemed UNSUBSTANTIATED at this time. Exit interview held. Copy of report provided.the state’s words, verbatim · CDSS document, Nov 6, 2024 · control 29-AS-20240620141647

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst (LPA) Zabel Chochian conducted an initial complaint visit regarding the above noted allegation. LPA initially met with staff who called the administrator. LPA spoke with administrator and explained the reason for the visit. Allegation reported was that the facility floors and baseboards are dirty. Upon arrival LPA conducted a tour of the facility with staff and observed facility to be well maintained and did not note anything in disrepair. Facility floors and baseboards observed clean during todays visit. Facility annual was recently conducted on 07/30/2024 and LPA did not observe facility in disrepair, dirty or unsanitary areas. Based on observation of the facility during today's visit and annual visit conducted on 07/30/2024, there is insufficient evidence to support the claim that the facility is dirty. Therefore, allegation "Facility is in disrepair" is deemed unsubstantiated at this time. Exit interview conducted copy of report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 7, 2024 · control 29-AS-20240731145531

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:14 AM. LPA was greeted by Facility staff who contacted the facility administrator Roxana Lara. Facility administrator arrived to the facility at approximately 09:20 AM Entrance interview conducted. Beginning at 09:22 AM, the LPA, along with facility administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. Cameras that do not record audio were observed in the common areas. A properly screened fireplace was noted in the living room. The LPA observed the fire extinguisher to be fully charged and purchased on 04/24/2024. Smoke detectors and carbon monoxide detectors were tested at 10:53 AM and were functional at the time of the visit. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days perishable and two (2) days non-perishable food and emergency water. The LPA observed one designated cabinet where knives and sharps are stored locked and inaccessible to residents. GARAGE: The entry to the garage was observed to be locked and inaccessible to residents. The garage was observed to contain a washer and dryer, laundry supplies and chemicals are stored in in the garage along with various cleaning supplies. Garage contained adequate emergency food and water supplies. Report Continued on LIC 809-C Continued from LIC 809-C BATHROOMS: There are three (3) bathrooms for resident use. Bathrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed next to all toilets and in all showers and all were properly secured. The water temperature was measured between 105.8 and 109.8 degrees Fahrenheit, which is in compliance with regulation. BEDROOMS: There are seven (7) bedrooms in the facility; six (6) are designated for resident use and one (1) is designated as a staff room. One (1) resident room was observed to lack a bed for the resident’s use. However, interviews with resident 1 (R1) confirmed that this was at their request and that they preferred to sleep in a recliner. All other resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. OUTDOOR SPACE: The backyard has sufficient patio furniture including shaded tables and chairs for resident use. One outdoor shed was observed to contain extra care supplies. Facility has two exit gates that were observed to fail to self-latch, LPA observed clear passageways for emergency exit use. RECORD REVIEW: At 10:26 AM staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. No deficiencies were observed during records review. MEDICATION REVIEW: Medications for 2 (two) of five (5) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet and no deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Last emergency disaster drill was conducted 05/30/2024. The facility’s emergency disaster plan is up to date and adequate. Report Continued on LIC 809-C Continued from LIC 809-C INTERVIEWS: LPA interviewed two (2) staff and three (3) residents. All residents were happy with the food and activities offered. All residents stated that staff treat them well and are attentive to their needs. Both staff were knowledgeable on resident rights, the different forms of abuse, and their roles and responsibilities. During today’s visit LPA obtained a copy of the facility’s updated LIC500 and liability insurance. Due to a previous obligation administrator Roxana Lara had to leave the facility before a copy of the report was issued. Administrator has designated manager assistant Markdel Estrada to receive and sign the report in their absence. The following deficiencies were observed (See LIC 809-Ds) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Licensee was advised that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 30, 2024

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.