Routine inspection·March 14, 2024

At 9:50 a.m. Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by a caregiver and granted access. Caregiver requested LPA check temperature on temperature reader affixed to the entry wall and asked LPA to sign in. LPA called the Administrator Daisy Hailey and notified Administrator reason for the visit. Administrator would not be present and assigned Caregiver Eufemioike Rodriguez to sign the report. Caregiver is the only staff member currently present at the facility. There are four (4) residents present. LPA observed that there is one (1) bedridden resident, but facility is not approved or have a fire clearance for bedridden. Facility is approved for two (2) ambulatory and four (4) non-ambulatory with three (3) hospice waivers. Three (3) residents are on Hospice Care. LPA explained to Caregiver that an immediate civil penalty of $500 would be issued. At 11:30 a.m. LPA and Caregiver toured the physical plant of the facility, and the following was observed. Common Areas : The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished. No obstructions or tripping hazards throughout the facility. LPA observed all trash cans throughout the facility have fitted lids. Kitchen: The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed cleaning products kept locked under the kitchen sink. LPA observed knives locked in a kitchen drawer. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable food properly stored. On a wall leading to the kitchen LPA observed one (1) fire extinguishers fully charged with a last serviced date of 05/08/2023. Dining area had a table and chairs to sit the capacity of the facility. Continued on LIC809-C Bedrooms: LPA inspected five (5) out of five (5) resident bedrooms. One (1) out of the five (5) bedrooms is a shared bedroom. LPA observed each private resident room to be properly furnished with one bed, appropriate nightstand, chair, bedding and with sufficient lighting and storage. LPA observed an air mattress and twin bed in the shared bedroom. LPA asked Caregiver who sleeps in the air mattress and Caregiver indicated they sleep in the shared room occupied by one resident. Caregiver was asked to remove the air mattress. Bathrooms: The facility has three (3) bathrooms. Water temperature in bathrooms was measured, temperature was 117.5 degrees Fahrenheit. LPA observed the bathrooms to be clean and properly supplied with toilet paper and trash bins with lids. Laundry/Garage: Laundry room leading to the garage and staff bedrooms is kept locked and inaccessible to residents. Detergents are kept locked in the laundry room. At 11:50 a.m. LPA observed Caregiver test the hardwired, interconnected smoke detector located throughout the facility. Detectors were observed to be functioning properly. LPA observed the carbon monoxide detector functioning properly. Outside Areas: LPA toured the outside area of the facility. LPA also observed a clean covered patio and backyard furniture to accommodate the six (6) residents. There were no bodies of water observed. Resident Files : LPA conducted a file review of resident records to ensure compliance with licensing forms. Yearly Physician reports were missing in three (3) out of four (4) records. Staff Files : LPA conducted a file review of staff records to ensure compliance with licensing forms. Two (2) out of three (3) staff records are missing ongoing training. Medications : LPA and Caregiver reviewed medication and medication records for proper documentation. Administrative: Annual fees are current. LPA collected LIC500 and Resident Roster. Certificate of Liability Insurance will be emailed to LPA. Please see LIC809-D for civil penalties and citations. Citations issued during this visit. LPA explained civil penalty of $500 would be issued and that two (2) repeat violation civil penalties of $250 each would be issued. Appeals rights explained and provided. Exit interview conducted. Copy of report given to the Caregiver.