Routine inspection·May 9, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Jacqueline Hernandez and explained the reason for the visit. Facility is licensed to served 206 elderly residents age 60 and over, ambulatory and non-ambulatory. Rooms excluded from non-ambulatory status are #110, 221, 222, 243. The facility is a two story building located in a residential neighborhood. It consist of several resident bedrooms in both floors, a lobby seating area, offices, a dining room, a coffee bar, a studio dining room, a commercial kitchen, a medication room, a common shower, an activity room, a family room, a parlor, a courtyard in the first floor, a conference room, a TV room, a library, and patio in the second floor. LPA toured the facility with Jacqueline Hernandez and observed the following: First Floor: Lobby and family room are clean in good repair, fireplace is covered. Dining room has an uncovered rectangle shape hole of about 4ft x 3ft. Per maintenance a leak was noticed this morning and the hole was cut to prevent leaking. Kitchen was observed clean, sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. List of special diets posted. Egress exit doors were checked down stairs and in working condition. Passageway from the exit door of the laundry was tested. LPA observed a food tray cart, trash cans, and laundry moving cart blocking the exit at the end of the passageway by the parking lot. Local Ombudsman and PUB 745 are posted in the hallway to the parlor. Parlor is clean and in good repair. Medication room and carts located in the studio dining room were observed locked. Emergency food supplies were observed in a closet by the kitchen. Common shower across from the elevator does not have skid strips/mats. Second Floor: Library's fireplace is covered, TV room, conference room were observed clean and in good repair. Three (3) egress exit doors were tested and are in working condition. Emergency evacuation chairs were observed at the top of each exit door. (CONTINUED ON LIC 809C) A total of 9 randomly picked resident bedrooms were observed and each have the required furniture, bedding supplies, and sufficient lighting. Each room has a private bathroom, LPA tested water temperature in each and tested between 110.1 - 122.1 degrees F., which is not within the required 105-120 degrees F. Facility has a fire sprinkle system throughout the building. Fire extinguishers were observed and last checked on 7/10/23. Courtyard is enclosed and has sufficient seating shaded area. Upstairs patio is fenced and has a sufficient seating area. Water feature pond is fence around. This facility serves as a dementia building, LPA reviewed medication with Med-Tech staff for 9 residents. LPA reviewed files for 8 residents. During today's visit LPA completed the following domains: Physical Plant and Environment Safety Resident Right - Information Food Services Incidental Medical and Dental Resident Record - Incident Reports Planned Activities LPA will return at a later time to conclude the annual visit and finish additional CARE tool inspection domains. Deficiencies were noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Annabelle Argenal and a copy of this report, LIC 809D, and appeal rights were provided.