Routine inspection·May 13, 2024

On 05/13/2024 at 2:55 p.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility listed above to conduct an unannounced annual inspection using the CARE Inspection Tool. This is an Residential Care Facility for the Elderly (RCFE), with an approved fire clearance for a capacity five (5) non-ambulatory residents of which one (1) can be bedridden. LPA was greeted by the administrator Josephine Miranda and LPA explained the reason for the visit. An entrance interview was conducted. LPA requested a copy of the facility's Infection Control Plan as the Mitigation Plan submitted on 4/21/2021 was documented as incomplete. Administrator informed LPA they do not recall receiving information the plan was not complete. Administrator could not provide a copy. At approximately 3:10 p.m. LPA and the administrator toured the physical plant of the facility, and the following was observed. Kitchen/ Dinning areas: The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable supply of food; properly stored. LPA observed one (1) fire extinguisher fully charged. Dining areas had appropriate table and chairs to sit the capacity of the facility. In the formal dining area LPA observed paper and boxes filling one side on the table and dining area. LPA observed, first aid kits, client medications, kept locked in a kitchen cabinet. LPA observed two (2) facility telephones, operational. Bathrooms: The facility has three (3) total bathrooms one (1) of which is in a shared bedroom for resident use. At 3:41 p.m. LPA tested the hot water temperature in one of three resident bathrooms. The hot water temperature measured approximately 109.6*F, within regulation. LPA observed both bathrooms to be clean and properly supplied with toilet paper, hand soap, paper towels and trash bins with lids. Bedrooms: There are a total of six (6) bedrooms, one (1) of which is designated for staff use. LPA inspected five (5) out of five (5) resident bedrooms. LPA observed each resident room to be properly furnished with beds, appropriate night stand, bedding and with sufficient lighting and storage. LPA observed extra linens in the hallway outside the bedrooms. (Continued on LIC809-C ) (Continued from LIC809) At 3:45 p.m. LPA observed the administrator test a smoke detector that is hardwired and interconnected to other detectors located through out the facility. Detectors were observed to be functioning properly. Due to time restraints, LPA was unable to complete the annual visit at this time. LPA did not review any staff or resident records or medication documentation at the time of this visit. A follow-up visit will be conducted at a later date to complete the annual inspection. Exit interview conducted/Copy of report given