Routine inspection·September 4, 2025

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Victoria Valera and Edmar Limoico, Care Staff and explained the purpose of the visit. Shortly after, Administrator Orlando Valera arrived and assisted LPA with the inspection. The facility is approved to serve elderly clients. Fire cleared for (6) non ambulatory clients. Hospice waiver approved for (2) clients. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Operational Requirements: A fire clearance is in place. Fire Drill is conducted monthly and the last drill was conducted on 08/05/2025. Facility has working signal systems in exit points. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which consists of (4) resident bedrooms, (1) staff bedroom, (1) office/bedroom, (2) bathrooms, living room with covered fireplace, kitchen, dining area, laundry area in the attached garage and backyard with shaded patio area. There are currently (5) residents, 60 years and older residing in the facility, no one is under hospice care. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. LPA observed cameras in the common areas with no audio. Backyard was inspected and has a shaded area and sitting area. There are (2) fire extinguishers in the facility which was purchased on 12/30/2024. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Water temperature reading measured within the required 105 - 120 degrees Fahrenheit. 10:50am, readings were 114.4 deg. F in bathroom #1 and 113.9 deg F in bathroom #2. *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of (8) caregivers including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Five (5) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB sc reenings. Administrator has completed the required Administrator courses and submitted the certification renewal. Administrator's certificate valid through 08/21/2026. Resident Rights-Information: Resident personal rights are posted. Visiting policy is posted at a location that is visible and accessible to residents and families. Facility provides internet services to all residents and have access to the facility phone. Planned Activities: Information regarding Dementia is part of training for direct care staff and is included in the Plan of Operation. The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Pesticides and cleaning supplies are kept away from the food preparation areas. Incidental Medical Services: All (5) residents' medications were reviewed during the visit. Resident #2 (R2) is taking nonprescription PRN without a written order from a physician and not on the medication list. Resident #1 (R1) has a written order from the Physician for PRN medication, but the label on the PRN medication being administered is incorrect. The f acility uses the Medication Administration Record (MAR) log to document medications given. Medications were stored in the office cabinet and inaccessible to residents. First-aid supplies along with a manual are maintained in the facility. Resident Records-Incident Reports: Five (5) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records. Staff failed to sign the Medication Administration Record (MAR) on the correct time and date (8am/Sep. 4, 2025) for one of the resident (R2). Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. The facility conducts emergency drill on a monthly basis. Last fire drill was conducted on 08/05/2025. Residents with SHN: None of the residents is under hospice care. Physician orders for use of half bed rails were reviewed in (5) residents files. (1) out of (5) residents did not have a bed rail physician's order on file. Deficiencies cited, Technical Violation issued. Exit interview and a copy of this report along with the appeal rights was provided to the Administrator, Orlando Valera.