Pre-licensing visit·March 30, 2023

Licensing Program Analysts (LPA) Christina Valerio and LPA Kim Viarella arrived to the facility unannounced to conduct a pre-licensing inspection. LPAs met with facility staff, and explained the purpose the visit. LPAs were later met by licensee/administrator Sylvester and staff Chukwidi "Patrick" Ikiseh. The facility is currently going through a change of ownership. The facility has a fire clearance for 6 non-ambulatory residents. Observed there are 4 residents in care at this time. Licensee Sylvester will be the designated Administrator for this facility. Certificate #6036359740 Expiration 07/05/2023. LPAs toured and inspected the physical plant inside and outside to ensure there are no health and safety concerns. LPA’s observed the kitchen area, dining area, bedrooms, bathrooms, garage, and office. The facility is a 4 bedroom, 2 bathroom home with a kitchen area, dining area, and living room area. Residents have access to all areas except laundry room, medication closet, garage, and part of the backyard that is fenced off. All emergency exits have appropriate signage. The facility has an emergency disaster plan on file. LPAs observed smoke detectors and carbon monoxide detectors were functioning properly. LPAs observed no obstruction of emergency exits inside or outside of facility. LPAs observed the area where the staff and resident files are locked and readily available for review. LPAs reviewed staff and resident files. Staff and Resident files were observed to be incomplete. This poses an potential health and safety risk to residents in care. Resident bedrooms observed to have necessary furniture. Resident bedrooms are furnished with a bed, chair, night stand, personal dresser, and a closet space. Resident bathrooms observed to have non-skid mats, soap, paper towels, and closed lid garbage cans. Hot water temperature was measured to read 116.1* F, which is within the regulatory range of 105-120*F. Continues on LIC 809 - C... Continued from LIC 809 LPAs observed the kitchen area. LPAs observed cold medication on the top counter and medication in an unlocked cabinet next to cups and plates. This poses an immediate health and safety risk to residents in care. Administrator removed the medications immediately and had staff lock them away. LPAs observed area where food supplies of nonperishable foods for a minimum of one week, perishable foods for a minimum of two days. The facility was observed to have an emergency supply of food/water. LPAs observed fire extinguishers to be fully charged and last inspected on 05/23/22. First aid kit was observed to be fully stocked, located in locked medication cabinet. LPAs inspected exterior grounds. LPAs observed a shaded area for visitors for outdoor siting, a garden area, and areas clear of obstructions. LPAs observed two sheds on the side of the home. Both sheds are noted to be out of compliance and considered an immediate health and safety risk to residents in care. A brown plastic shed was observed to be unlocked and had miscellaneous items, including lighter fluid. Another blue shed was observed to have a twin bunk bed, a dresser, and chair located inside. The sheets were not dirty, the floors had cigarette buds on the floor, and the dressers were observed to be empty. The beds were fully made with sheets, blankets, and pillows with pillow cases. According to Administrator Sylvester, they do not use the shed and this was from the previous licensee. This poses an immediate health and safety risk to residents in care. LPAs observed the garage. LPAs observed a corner in the garage with a sofa bed, a sheet on top of a mattress with a mattress against the wall, and a locked closet. According to interviews, there is no live-in staff. LPA observations indicate otherwise as evidence by phone charger, toiletries, and personal items. There was a locked cabinet near the beds at the start of the visit, which staff indicated they did not have a key to the lock. In the middle of the visit, the closet was unlocked and contained empty hangers, medical scrubs, and plastic drawers. Administrator stated that he has not touched the previous licensee's items and that staff use this area for a break room. According to the facility sketch, there is no indication of a staff office/room. Administrator stated he will work on getting the items removed. This poses an immediate health and safety risk to residents in care. Continues on page 3, LIC 809 - C... ... Continued from page 2 LIC 809 C LPAs observed residents in their room eating breakfast, getting assistance with ADLs from staff, and watching television. LPAs observed family members signing in to visit residents in care. LPAs interviewed residents and staff during the visit. Pre-Licensing is incomplete with deficiencies to be resolved 04/07/23. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies.