Routine inspection·October 10, 2024

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 10/10/24. LPA met with the administrator, Richard Rabena, and explained the reason for the visit. The facility is licensed to serve 6 residents ages 60 and over, of which 5 may be non-ambulatory and 1 bedridden. Room #7 is approved for the bedridden resident. There is a hospice waiver approved for 2 residents. LPA inspected the facility using the CARE tool and observed the following. The single story facility consists of 5 resident bedrooms, 2 Staff rooms, living/dining room, family room, kitchen, 2 bathrooms, and the attached garage. Staff room #1 has a private bathroom. The backyard has a shaded area for resident use. The hot water temperature was measured between the required range of 105-120 degrees F. There are no swimming pool or bodies of water on the premises. The facility has a carbon monoxide detector located in the hallway. Sufficient food supplies of 2 day perishable and a week of non-perishable are observed. Facility has sufficient space to provide indoor and outdoor activities to residents. Facility accepts and retains residents with dementia. Staff are ensuring that incontinence residents are changed often and the facility remains free of odor from incontinence. There are currently no residents with prohibited or restricted health conditions. No residents are using oxygen equipment. Medications are centrally stored and locked in the hallway cabinet. LPA reviewed 4 resident files and medications. Resident #4 did not have the annual medical assessment on file. Medications are being administered as prescribed. LPA reviewed 3 personnel files. The files have the required forms and health assessment with TB test results. Annual training are being provided to staff. Administrator's certificate expires on 7/27/25. The Emergency Disaster Plan is reviewed annually and has the emergency procedures indicated. A deficiency is issued on the LIC809D form. An exit interview was held and a copy of this report along with appeal rights was given to the administrator.