Routine inspection·July 15, 2024

At 9:50 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Administrator, Elena Angustia and explained the reason for the visit. At 10:20 AM, physical tour was conducted with the Administrator and LPA observed the following: Kitchen: At approximately, 10:21 AM 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. LPA observed a scissor in one of the drawers in the kitchen accessible to residents in care. LPA also observed roaches crawling on the kitchen food, utensils, walls, and inside the fridge. LPA also observed a think pile of grease/dust in the kitchen. A spray of Ant & Roach (Raid Brand) was also observed and accessible to residents in care. Other knives were observed locked. All trash cans were observed without a tight-fitting lids. Medications: At approximately, 10:22 AM LPA observed medications are centrally stored and locked in a kitchen cabinet. LPA observed over the counter medication for severe congestion & cough in Bedroom # five (5), and two full bottles of Lactulose 10 Gram in Bedroom # two (2) accessible to residents in care. Additionally, review of R1's random medication revealed that the facility has a full completely sealed bottle of Atorvastatin 10MG to prevent heart attack, or stroke which was filled on 10/30/2023, with 100 tablets. A second empty bottle of Atorvastatin 10MG with one hundred (100) tablets, date filled on 02/20/2024, was observed empty. LPA did not observe any new bottle or any discontinuation notes on the Centrally Stored Medication and Destruction Record (LIC 622). LPA asked the Administrator and the staff for explaining and both staff could not provide any answers. A deficiency will be cited. Continue on LIC 809C Bedrooms: The facility has five (5) resident bedrooms of which three (3) were vacant. There was one room designated for staff. All resident bedrooms, including the vacant rooms, were properly furnished and supplied with appropriate bedding and linens. Rooms observed to have bedspread, sheets, pillowcase, LPA observed roaches in the resident’s bedrooms as well as spider webs in the ceiling. One of the vacant bedrooms also had a leak in the corner of the closet in the ceiling and the upper portion of the wall. Trash cans did not have any tight-fitting lids. Bathrooms: LPA observed two (2) bathrooms and both needed to be clean. The sink in one of the bathrooms was clogged. LPA also observed two (2) bottles of Cloralen with bleach sprays in the bathroom cabinet accessible to residents in care. The bathrooms were properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and resident's bathroom had non-skid mat. At 10:41 AM, hot water temperature measured at 150°F. Common Areas : The facility maintains a comfortable temperature at 78°F. The living room and dining area did not appear clean. They were furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. The fire extinguisher by the front door and in the kitchen were expired and were dated from 12/06/2018. Outside areas: At approximately, 10:45 AM, LPA toured the outside area of the facility. There was a locked fenced area designated for laundry and laundry detergents were observed locked. The facility has four separate storage rooms. Two out of four storage rooms were observed unlocked of which one storage room had paints and other chemicals. All windows and door paths from inside and outside needed cleaning. Smoke detectors/carbon monoxide . Smoke detectors were located throughout the facility, and at 10:55 AM they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational. Continue on LIC 809C Between 11:30 AM, to 1:00 PM, LPA reviewed records of two (2) residents and two (2) staff. LPA observed two out of two resident records were incomplete and missing forms. Appraisal/Needs and Services Plan (LIC 625) and Physician Report (LIC 602A) were missing. LPA observed that two (2) out of two (2) staff did not have valid/current First Aid/CPR training on file. Residents and staff records did not appear to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Deficiencies cited during today’s visit. Appeal rights explained. Exit interview conducted and copy of this report signed and delivered.