The Elderly Inn III

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Administrator, Marinela Barac. A separate report was created to document today's annual inspection. LPA observed (2) residents resting and watching television in the front common area. This report was created to clear the Post Licensing inspection in the system. There are no citations issued in this report. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Administrator, Marinela Barac. LPA observed (2) residents in the common area and (2) residents in their rooms. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice. LPA and the Administrator toured the interior/exterior of the facility including the common areas, (5) resident bedrooms, (3) resident bathrooms, kitchen, staff room and laundry area. LPA observed the facility to be clean, in good repair and odor-free and the bathrooms to have the necessary grab bars, skid-resistant flooring and hygiene items. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen and medications are locked nearby. Additional toxins are locked in the laundry area. The inside temperature measured 74*F and hot water measured 120*F in a resident bathroom. The fire extinguisher was last serviced 6/24/2025, and the smoke/monoxide alarms are functioning. There are sufficient paper, incontinent and PPE supplies. Required postings are in the common area as well as the current Administrator Certificate #700491740- exp 5/30/26. There is (1) unlocked exterior gate, covered seating and no bodies of water. There is an alert on front exit door and other exit doors. All windows screens are in good repair. LPA reviewed (2) resident files and (2) staff files- files are organized and contain current documentation, including for required staff training. Medications were reviewed for (1) resident- orders match medications being administered. An Addendum will be added to the Admission Agreement to reflect regulation updates. LPA obtained an updated copy of liability insurance. LPA provided a copy of Regulation 87463 and discussed multiple topics. There are no citations issued in this report. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual and met with Administrator, Marinela Barac. LPA observed (3) residents watching television in the common area and (1) resident in their room. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice. LPA and the Administrator toured the interior/exterior of the facility including the common areas, (5) resident bedrooms, (3) resident bathrooms, kitchen, staff room and laundry area. LPA observed the facility to be clean, in good repair and odor-free and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen and medications are secured nearby. The inside temperature measured 75*F and hot water measured 120*F in the kitchen and in a resident bathroom. The fire extinguisher was last serviced 7/10/24, and all smoke/monoxide alarms are in working order. (Administrator to regularly check the hot water temperature and the fire alarms, at least twice/annually, to ensure the batteries are working). There are sufficient linens/blankets/incontinent/PPE supplies, and a complete First Aid kit. Required postings are in the common area as well as the current Administrator Certificate #700491740- exp 5/30/26. There are night-lights throughout, including next to the bathrooms. There is (1) unlocked gate from the inside back patio, covered seating and no bodies of water. LPA provided the flyer "Important Updates to Dementia Care and Miscellaneous Changes" effective 1/1/25 and discussed some changes in detail. LPA reviewed (2) resident files and (2) staff files- files were found to be organized and contain current documentation, including for required staff training. Medications were reviewed for (1) resident- orders match medications being administered and required documentation is maintained. LPA obtained an updated email address and requested an updated copy of liability insurance, LIC500 and LIC308 be provided by 1/21/25. There are no deficiencies issued. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Administrator, Marinela Barac. LPA observed (2) residents watching television in the common area and (1) resident in her room. LPA was advised there is currently (1) resident who remains hospitalized after being sent out a few days ago. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice. LPA and the Administrator toured the interior/exterior of the facility including the common areas, resident bedrooms (5), resident bathrooms (3), kitchen, staff room and laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps and toxins are locked in the kitchen and medications are secured nearby. Additional toxins are locked in the laundry room. Inside temperature measured 76*F and hot water measured 116*F in the kitchen. Fire extinguisher was last serviced 7/18/23 and smoke/monoxide alarms are in working order. There is sufficient linens/blankets/incontinent/PPE supplies, and a complete First Aid kit. Required postings are posted as well as the current Administrator Certificate #6016837740- exp 5/30/24. There is (1) unlocked gate from the inside back patio and no bodies of water. LPA reviewed the Infection Control Plan (LIC9282) and found it to be very comprehensive with additional pages for specific illnesses. LPA and Administrator discussed updated forms, including Personal Rights and LPA printed some out. LPA reviewed (2) resident files and found them to be organized and contain current documentation. Medications were reviewed for the same residents- orders match medications being administered and medications are being logged and PRN dosages given are being recorded. LPA reviewed (2) staff files and found them to also be organized, complete and current with documentation of required training. Administrator has current certification in First Aid/CPR and new staff will obtain it. LPA obtained an updated copy of liability insurance. There are no deficiencies issued but there is a Technical Advisory Note. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 12, 2023