Routine inspection·April 2, 2025

At 10:00 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by a staff #1(S1) and granted access. LPA signed in and checked temperature. LPA informed staff #2(S2) the reason for the visit and to inform the administrator LPA was at the facility. S2 called the owner Anne Gregorio and informed her LPA was at the facility. S2 informed LPA the owner would meet with LPA shortly. There are two (2) residents present. LPA observed resident #1 (R1) in the living room with a visitor and resident #2(R2) was in their private bedroom. At 10:16 a.m., LPA toured the physical plant of the facility inside and out and the following was observed. Common Areas : LPA observed appropriate postings at the entry of the facility. The facility maintains a comfortable temperature of 76°F. The living room and dining area were clean, clear of clutter and were properly furnished. Dining area had a table and chairs that sit the capacity of the facility. Living area had a television and seating for the capacity of the facility. LPA tested two (2) of two (2) carbon monoxide detectors and they were observed functioning properly at 10:23 a.m. Kitchen: The kitchen was observed to be clean and clear of clutter. Appliances and fixtures were functioning properly. LPA observed knives locked in a kitchen drawer. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable food. On a wall leading to the kitchen LPA observed one (1) fire extinguisher fully charged with a last serviced date of 05/02/2024. 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 resident room to be properly furnished with one bed, a night stand, one chair, bedding, sufficient lighting and storage. LPA opened exterior doors in all resident bedrooms and observed the auditory alarms were functional. (Continued on LIC809-C) (Continued from LIC809) Bathrooms: The facility has three (3) bathrooms. One (1) bathroom is in the shared bedroom. Hot water temperature in two (2) bathrooms was measured, temperature was between 119.1°F and 120 °F, within regulation. LPA observed the bathrooms to be clean and properly supplied with toilet paper and hand soap. LPA also observed grab bars and non slip shower mats. 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. In the garage LPA observed a freezer with food and extra facility storage. At 10:54 a.m., LPA observed S2 test the hardwired, interconnected smoke detector located throughout the facility. Detectors were observed to be functioning properly. Outside Areas: LPA toured the outside area of the facility. LPA observed a covered patio and outdoor furniture for resident use. Passageways were clear and there were no bodies of water observed. LPA met with the Licensee. LPA observed a register of facility residents (LIC9020) and observed resident #3's (R3's) name. According to staff and the license R3 passed away on February 10, 2025. Licensee informed LPA the report would have been faxed to the regional office. LPA advised report was not found on file. At 12:15 p.m., LPA met with staff #3(S3) who will be signing todays report. Resident Files : At 12:26 p.m., LPA conducted a file review of one (1) of two (2) resident records to ensure compliance with licensing forms. Medications : LPA and S3 reviewed medication and medication records for proper documentation. Staff Files : LPA conducted a file review of four (4) staff records to ensure compliance with licensing forms. S1 was designated as a volunteer. LPA observed S1 providing assistance to R1 with other staff present. Two (2) out of four (4) records reviewed are missing health screening documentation to verify staff are physically and mentally capable of performing assigned tasks . S1 was missing a signed statement affirming that he/she is in good health and a chest x-ray or an intradermal test on file. LPA observed an LIC500 and Resident Roster. Certificate of Liability Insurance will be emailed to LPA. At 2:28 p.m., LPA reviewed R2's record to ensure compliance with licensing forms. Exit interview conducted. Deficiencies cited (refer to LIC809-D). Appeal rights explained and provided. Copy of report provided.