The Norma J's Home for the Elderly III

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival, LPA met with staff and explained the reason for the visit. Administrator Loretta Louise Tiede arrived shortly after. LPA 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. LPA inspected the kitchen/food service area at approx. 11:40 a.m. Knives and sharp objects are stored in a locked drawer to the left of the stove. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored at this time. At the time of the visit, the common area furniture's were observed to be in good condition. A sufficient supply of clean linen and towels were observed stored in a hallway closet and cabinets. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. LPA observed fire extinguishers to be fully charged and last serviced on 10/26/2025. Facility consists of five (5) resident bedrooms, four (4) bathrooms in the main house; one bedroom and one bath in the back house. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured between 105 - 120 degrees Fahrenheit. All exits have functioning auditory devices and were operational at the time of the visit. The LPA observed required postings throughout the common areas. There is an attached garage observed inaccessible to residents in care. LPA observed garage to have a laundry area and to store, extra incontinent supplies, linen, PPE , as well as additional furniture and medical equipment for facility use. Continued from 809 The backyard has a covered outdoor area equipped with furniture including a table and chairs for resident use. The LPA observed one (1) self-latching gate with clear passageways clear of obstruction. Records review, Five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Four (4) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were observed to be in order at this time . Medication review, medications for all residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Infection control / Emergency Disaster plan: 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. Emergency disaster drills are to be conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/06/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. Smoke detectors and carbon monoxide detectors were tested, all alarms were functional at the time of the visit. During today’s visit LPA obtained a copy of the facility’s LIC 500 and resident roster. Exit interview conducted and copy of the report was issuedthe state’s words, verbatim · CDSS document, Jan 16, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a Required Annual visit. Upon arrival LPA was greeted by staff and Administrator. Reason for visit was stated. LPA was informed and observed the home was experiencing a power outage during the visit. Administrator stated that the power was shut off due to the winds (shut off estimated for 8hrs). LPA and Administrator discussed emergency disaster plan, and best practices. Facility has a generator, for needed power during outage. Residents will relocate with family if needed. At approximately 2:30p.m., the LPA conducted a tour of the physical plant with Administrator and staff to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility consists of five (5) client bedrooms, four (4) bathrooms in the main house; one bedroom and one bath in the back house. The LPA observed fire extinguisher, which was fully charged and last serviced 10/15/2024. All smoke alarms and carbon monoxide detectors were tested and operable. Required postings observed on the wall. Administrator will get a poster size of the state complaint poster. BEDROOMS/ BATHROOMS: LPA inspected the bedroom and bathroom areas. Bedrooms were furnished appropriately with clean linens, appropriate furnishings. The resident restrooms were clean and 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 is within required range (105-120*f). COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature (76 degrees). Smoke detector(s) and carbon monoxide detector were tested and were operational at the time of the visit. OUTDOOR AREA: The backyard has a outdoor area equipped with furniture for resident use. No bodies of water noted and exits are free of obstructions. The garage is attached, locked and inaccessible. Garage is where the washer and dryer are held, including additional refrigerator with perishable food items. Cleaning supplies and disinfectants are kept in locked in the garage. The facility keeps a sufficient amount of emergency food supplies and water in the garage. Due to time constraints annual inspection will continue on a later date to review staff, residents and medication records. No deficiencies issued during todays visit. Exit conducted and copy of report issued.the state’s words, verbatim · CDSS document, Jan 15, 2025

Type of visit: Required - 1 Year

At 2:30 p.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. Licensee Loretta Tiede arrived shortly. At 2:40 p.m. the LPA conducted a tour of the physical plant with the Licensee to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single-story residence that consists of six (6) resident bedrooms, and five (5) restrooms. The LPA observed two (2) fire extinguisher which were fully charged and last services on 10/17/2023. All smoke alarms and carbon monoxide detectors were tested and functioned properly. The LPA observed all required postings in the hallway near the entrance area. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are always available for the residents. Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding. Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. The water temperature in resident’s restroom in bedroom #2 was measured at 116.9 degrees Fahrenheit. The hot water measured was within the required limit of 105-120 degrees Fahrenheit. Report will continue LIC809-C. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. There were no obstructions and/or tripping hazards throughout the facility. The garage: The LPA observed the garage where additional supplies and the emergency food and water is stored. Cleaning supplies and disinfectants are kept in the garage. The garage is locked. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. Interviews: The LPA conducted one (1) resident Interview. No immediate concerns were voiced. Record Review: A review of facility files was initiated. However, due to time constraints the LPA will return at a later time to complete the annual. Exit interview conducted and copy of the report provided Licensee Loretta Tiedethe state’s words, verbatim · CDSS document, Jan 19, 2024