Routine inspection·February 13, 2025

At 9:30 AM, Licensing Program Analysts (LPAs) Nadia Shahbazian and Mariana Agban conducted an unannounced mandated annual inspection of the facility. LPAs met with the administrator, Nathaniel Hemedes, and explained the reason for the visit. At 9:45, a tour of the facility was conducted with the Administrator, and LPAs observed the following: The facility's total capacity is approved for six (6) non-ambulatory residents. The current census is five (5) residents. Kitchen: At 9:45 AM, LPAs toured the kitchen area and observed enough supplies of staple non-perishable for a minimum of 1 week and perishable for 2 days at the facility. All knives and sharps were observed to be locked in a kitchen drawer. The medications cabinet was locked. LPAs observed a roach on the kitchen wall by the food table. LPAs also observed medications in the fridge without being locked. LPAs also found bags of medications on the floor. The administrator stated that those medications will be destroyed. Under the sink cabinet LPAs found chemicals were unlocked. Laundry: The laundry is located between the kitchen and garage. LPAs observed unlocked laundry detergents accessible to residents in the laundry room. LPAs observed a fire extinguisher hanging on the wall purchased on 08/12/2019. Administrator was advised to buy a new fire extinguisher. (continue on 809 C) Bedrooms: The facility has six (3) bedrooms in total. All bedrooms were clean and odorless. Furniture was in good repair. All bedrooms are designated for shared use. LPAs observed in Bedroom #1 stow away bed. Interviews with R2 and R3 indicated that there was a caregiver who used to sleep in the room. LPAs also observed that R2 and R3 had half (½) bed rails. Review of R2’s and R3's facility records revealed that no Physician's order was available. LPAs advised Administrator to update residents' records and provide doctors' orders for residents' bedrails. Bathrooms: The facility had two bathrooms. Bathroom #1 is located in the main hallway. Bathroom#2, located in Room #2, LPAs observed both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 112.7 and 113.9 degrees Fahrenheit. LPAs observed in both bathrooms cleaning supplies under the cabinet sink. Administrator was advised to remove or lock chemicals. Common Areas: The facility maintains a comfortable temperature of 75°F. The living room and dining area appeared clean and were properly furnished. The living room has a television and comfortable furniture. No obstructions and or tripping hazards throughout the facility. Outside and Back Yard: LPAs toured the one side path and back yard. The emergency exit gate was unlocked, and the path was free from debris. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 11:00 AM, the smoke alarms were tested and were NOT observed to be operational. Carbon monoxide was in the living room and was also tested and observed to be operational. LPAs heard functioning auditory alarms on all exit doors. Resident Files: LPAs conducted a file review of resident records and observed five (5) out of five (5) residents' facility files were incomplete, missing forms and signatures. LPAs were informed that Resident#6 had deceased a month ago. Records review indicated that there was no Death report sent to CCL. Administrator was advised to submit death report to CCL promptly. (Continue on 809 C) LPAs interviewed R1 and R2, who stated the facility doesn't provide any activity and that they spend most of their time watching TV. LPAs asked the Administrator for an activity calendar. Administrator doesn't have one in place. Staff Files: LPAs also conducted a file review of staff records and observed that there’s there’s no physical file for the Administrator and Staff#2. Staff#3 employee file is incomplete and has missing forms. LPAs discovered that Staff#3 is cleared but not associated with the facility. Administrator was advised to associate Staff #3 promptly. Medications: Medication and Medication Records were incomplete. LPAs could not complete an accurate medication count due to the inaccuracy of the medication records. Exit interview conducted, citations and civil penalty issued. Appeal rights are given, and a copy of this report is signed and delivered.