Canyon View Residential Care Facility, Inc..

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an annual inspection and was greeted by caregiver Purification Guerina. LPA explained the reason for the visit, and observed (2) additional staff. A tour of the physical plant was conducted. The facility has a total of four (04) bedrooms, with one (01) staff room and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory of which six (06) may be bedridden and a hospice waiver for six (06). The current census is (5). Common areas: The living and dining room are neat and clean. The facility maintains a comfortable temperature. The smoke and carbon monoxide detectors were tested and operating. Fire extinguisher is located near the kitchen and observed to be fully charged. Kitchen was sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. There is an additional refrigerator located in the garage. Knives and sharps are observed to be locked and inaccessible to residents. The residents' rooms are adequately furnished with appropriate and clean bedding and linens. The facility has (2) gates that were easily accessible. Outside passageways were unobstructed and spacious for walking. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The bathroom was checked for cleanliness and proper operations. LPA observed, grab bars, non-skid mat, and shower chair. The hot water temperature was measured at 114.8°F. Soap and towels are available. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit, including manual. Resident and staff records reviewed. All updated and required documents were observed in files. Training records and CPR/First Aid was current and valid. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.

Licensing Program Analyst (LPA) Ab eye Duguma met wi th Purification Guerina for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 10: 00 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms, one (01) staff room and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory of which six (06) may be bedridden and a hospice waiver for six (06). The facility is currently occupying five (05) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen and observed to be fully charged and last inspected 09/04/2024. (continued on LIC 809-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 115.3°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.