Routine inspection·July 3, 2023

On 7/3/2023 starting at 10:00 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with Teresita Collong, Administrator (ADM) and explained the purpose of the visit. Administrators certificate (6037999740) is valid and expires on 12/2/2023. The facility’s fire clearance was approved for all six (6) non- ambulatory residents, which one resident may be on hospice. Upon entry, LPA observed two (2) staff and three (3) residents present during inspection. At 10:35 AM, Licensee, Antonia Mari arrived to the facility and greeted LPA. Starting at 10:18 AM, LPA toured facility with ADM including but not limited to seven (7) bedrooms, three (3) bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are private, and one staff room. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 75 Degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents'. The hot water temperature in residents’ common area bathroom was measured at 106.4 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day supply of perishable foods. Sharps and toxins were locked and inaccessible to residents'. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was observed last serviced on 5/9/2023. First aid kit was observed to be complete. Continue on Lic809-C Continued from Lic809 Starting At 10:57AM, LPA reviewed 3 of 3 staff records. At 11:30 AM, LPA reviewed 5 of 5 residents' record. At 12:05 PM, LPA reviewed a sample of 5 of 5 clients' medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 7/10/2023: · LIC 308 Designation of Administrative Responsibility · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (9 Pages) · Liability Insurance No deficiencies cited during visit. Exit interview conducted with Licensee, and a copy of this report provided.