Routine inspection·November 18, 2024

On 11/18/2024 at 12:33PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Caregiver Estanislao Martinez, spoke with Administrator, Jacqueline Adams via telephone, and explained the purpose of the visit. The Administrator arrived at 1:25PM. Facility has census of 4. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of five (5) bedrooms and two (2) bathrooms. One (1) bedroom occupied by staff. All outdoor and indoor passageways are kept free of obstruction. LPA did not observe any bodies of water. A comfortable temperature is maintained at 68 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 116.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 02/01/2024. Emergency Disaster Plan was last posted on 02/01/2024. First aid kit was observed to be complete. Fire drill was last conducted on 08/07/2024. Continued LIC809C. Continued from LIC809. Four (4) staff records were reviewed. During record review two (2) out of four (4) staff were missing FirstAid. LPA reviewed all four (4) resident records and sample of medications. LPA requested updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/25/2024: · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Client/Residents · Liability Insurance · Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided. Continue LIC809C