Inspection Report
Annual Inspection
Census: 4
Capacity: 10
Deficiencies: 0
Nov 19, 2024
Visit Reason
The visit was an unannounced required comprehensive annual inspection conducted by the Licensing Program Analyst to evaluate the facility's compliance with licensing requirements.
Findings
The facility was found to be clean, in good repair, and operating safely with no deficiencies cited. The inspection included a walkthrough, record review, medication audit, and verification of safety equipment and food service.
Report Facts
Bedrooms: 7
Bathrooms: 3
Water temperature: 109.2
Perishables food supply: 2
Non-perishables food supply: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michelle Echeverria | Licensing Program Analyst | Conducted the inspection and audit |
| Caroline Densen | Assistant Administrator | Met with Licensing Program Analyst during inspection |
Inspection Report
Annual Inspection
Census: 4
Capacity: 10
Deficiencies: 0
Dec 1, 2023
Visit Reason
The visit was an unannounced required comprehensive annual inspection conducted by the Licensing Program Analyst to evaluate compliance with regulations.
Findings
The facility was found to be operating within approved capacity and in safe, clean, and good repair conditions. No deficiencies were cited during the inspection.
Report Facts
Resident files reviewed: 4
Staff files reviewed: 3
Water temperature: 112
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rommel Densen | Facility Administrator | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Paola Guerrero | Licensing Program Analyst | Conducted the unannounced annual inspection |
| Efren Malagon | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 6
Capacity: 10
Deficiencies: 0
Jan 31, 2023
Visit Reason
An unannounced annual inspection was conducted with a focus on infection control to evaluate compliance with regulations.
Findings
No deficiencies were issued during the inspection. One technical assistance was provided regarding the untidy state of the backyard and dining area where items and supplies were observed throughout.
Report Facts
Personal Protective Equipment supply duration: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Victoria Chitgian | Licensing Program Analyst | Conducted the unannounced annual inspection visit |
| Romell Densen | Licensee | Facility representative met during the inspection |
Inspection Report
Census: 4
Capacity: 6
Deficiencies: 0
May 19, 2021
Visit Reason
The inspection visit was conducted for the purpose of an Increase of Capacity at the facility.
Findings
The facility was toured and found to have operable smoke and carbon monoxide detectors, locked medication storage, adequate safety measures including locked cleaning supplies and sharp objects, and sufficient clean linens and hygiene items. The facility was approved by the City of Hesperia Fire Protection Bureau for increased capacity and hospice residents. The facility was stocked with food, emergency supplies, and activities for residents.
Report Facts
Approved non-ambulatory resident capacity: 10
Bedridden residents allowed: 2
Hospice waiver capacity: 10
Hot water temperature range: 105.1
Hot water temperature range: 109.5
Perishable food supply: 2
Non-perishable food supply: 7
First aid kits: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rommel Densen | Licensee/Administrator | Assisted with the inspection and discussed the report |
| Caroline Densen | Licensee/Administrator | Assisted with the inspection and discussed the report |
| Javina George | Licensing Program Analyst | Conducted the inspection visit |
| Joel Esquivel | Licensing Program Manager | Named in the report header and narrative |
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