Routine inspection·June 6, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA Flores met with Maria Quizon and explained the reason for the visit. Facility is licensed to served 32 ambulatory residents and 80 non-ambulatory, of which 5 may be bedridden. First floor is cleared for bedridden and there is fire clearance granted for egress exits and fire alarm. There are no large bodies of water in the property. Facility is a 3 story building, with multiple activity/common areas, a commercial kitchen, and a memory care unit. Facility currently has 11 residents under hospice. LPA Flores conducted a tour of the facility with Maria Quizon and Maintenance Director and observed the following: Facility is in good repair indoor and outdoor. All common areas are in good repair with sufficient seating area. Environmental cleaning was observed. There are different fireplaces in the common areas which are cover with a glass door. Kitchen area was observed clean. Sufficient food was observed for at least 2 days of perishables and 7 days of non- perishables. Special diets were listed. A total of 7 resident rooms were randomly observed and each room was observed in good repair with sufficient lighting, the required furniture, and bedding supplies. Oxygen tank without a stand was observed in room #118. Cleaning solution was observed in room #222 in the night stand, resident has a dementia diagnosis and should not store cleaning solutions. Bathrooms were observed in each room, each has the required grab bars, and skid floor in the showers, and are in good repair. Shower in room #312 was observed with mole in the shower floor. Water temperature was tested between 97.5 - 122.8 degrees F., which is not within the required 105-120 degrees F. Fire alarm sprinkle system and fire extinguisher were observed throughout the facility and last checked on 1/3/24. Carbon Monoxide/Smoke detectors were tested and are in working condition. LPA tested alert button in random rooms and staff responded within 2 minutes. Facility provided shaded seating areas outdoors. Let us Know PUB 475, Local Ombudsman poster, and personal rights are posted by the mailboxes. Each stairwell has an evacuation chair on top of the stairwell. (CONTINUED ON LIC 809C) The facility currently has residents in quarantine due to an infection outbreak. LPA and administrator observed a staff exit room #229 which is under quarantine, red zone sign at the door and PPE cart outside. Staff was observed exiting without PPE equipment, no hand hygiene procedures were observed being perform after exiting the room. The facility has an egress system in place doors were tested and are in working condition. LPA reviewed medication and files for 7 residents. During this visit LPA completed the following domains of the CARE inspection tool: Operational Requirements, Physical Plan/Environment Safety, Resident Rights/Information, Planned Activities, Food Service, Incidental Medical and Dental, Resident Records/Incident Reports. LPA will return at a different time to finish the other domains. Deficiencies were noted today per Title 22 Regulations. Exit interview was conducted with Maria Quizon and a copy of this report, LIC 809D, and appeal rights provided.