Routine inspection·December 21, 2022

At 10:15am Licensing Program Analyst (LPA), Angela Panushkina, conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by Consuello Cipriano (staff), who granted access to the facility. The Administrator was contacted over the phone and LPA explained the reason for the visit. At 10:30am, LPA conducted a tour of the facility with staff and the following was observed: Kitchen: LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The fire extinguisher was last serviced on 04/11/2022. Medications: At approximately, 10:35am LPA observed medications are centrally stored and locked in a kitchen cabinet, area and inaccessible to residents in care. Bedrooms: There are three (3) bedrooms designated for residents use and have sufficient lighting. LPA observed full rails placed on bed. Facility has an extra room for the live-in staff members Bathrooms: At 11:00am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination. Common Areas : The facility maintains a comfortable temperature at 74°F. The living room and dining area appeared clean and were properly furnished and the fireplace is adequately screened. No obstructions and or tripping hazards throughout the facility. During the walk through, LPA opened the closet door, by the main Continue on LIC809-C entrance, and observed a container with medications prescribed to Staff #2 (S2). LPA requested to remove medications from the closet and place it in a locked cabinet, immediately. The garage: Laundry area is located in an attached garage and kept locked and inaccessible to residents. Extra PPE supplies and food storage was also observed Outside areas: At approximately, 11:10am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA also observed various items stored in the backyard which need to be stored out of the way. LPA observed old/broken washer and a dryer, broken night stand, two mattresses and a hospital bed. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Gate was unlocked and easily accessible to open. Smoke detectors/carbon monoxide . Dual smoke and carbon monoxide detectors were located throughout the facility, and at 11:30am they were tested and observed to be operational. Additional Visit Information: Upon arrival to the facility LPA was told the facility currently has two (2) residents of which one (1) out of two (2) residents comes to this facility from 7:00am - 4:00pm for five (5) to seven (7) days a week. LPA attempted to contact Mr. Lopez to inform that the facility cannot be used as an Adult Day Care and if this individual is going to be at the facility they have to have a file for him/her. LPA also observed staff feeding the individual. From 11:30am to 12:00pm LPA conducted review of resident files and observed the following: R1's facility file had an Admission Agreement completed, only, and rest of the documents were left blank. In addition, the Physician Report was missing and LPA was informed that R1 moved to this facility on 12/18/22 and the facility still haven't received the completed document from R1's physician. LPA did not observe any orders on file for a full bed rails for R1. Deficiencies issued per Title 22. Exit interview conducted, appeal rights discussed and copy of this report issued.