Routine inspection·April 28, 2023

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Titiarish Fields caregiver and explained the reason for the visit. D'arolyn Acevedo arrived 20 minutes later. The facility is licensed to serve 22 residents over the age of 60, of which (12) may be non-ambulatory and/or 12 may be bedridden in the 1st floor only, with a hospice waiver approved for 12 residents. The home is a two story building located in residential/commercial area and consist of the following; first floor has 10 bedrooms, 3 bathrooms, 2 closets, office space, and the kitchen; second floor has 8 bedrooms and 2 bathrooms, a front yard, a back yard, parking, and a laundry in the basement. LPA conducted a tour with Titiarish Fields and observed the following: Kitchen consist of a commercial stove/grill, sink, a pantry, refrigerator, and freezer inaccessible to the residents. LPA observed sufficient food. Kitchen and pantry floors were observed dirty during the visit. Each bathroom was observed with skid mats and grab bars and water temperature was tested as follow; bathroom #1(B1) tested at 157.9 degrees F., bathroom #2(B2) tested at 136.0 degrees F., bathroom #3(B3) tested at 141.4 degrees F., bathroom #4(B4) tested at 89.4 degrees F., and bathroom #5(B5) tested at 155.1 degrees F., which is not within the required 105-120 degrees F. LPA observed 5 resident rooms (room #1,#2,#5,#21,#2) and observed required furniture, bedding supplies, and sufficient lighting. Resident in room #1 was observed to have full bed rails and has a hospice plan and bed rail request on file. Front and back yard have shaded sitting area. No large bodies of water were observed. LPA reviewed medication and files for 5 residents and 5 staff files. Medication for Resident #1(R1) was stored in plastic bag and bottle was disposed. Administrator certificate was observed for Gregory Restum #600 exp. date: 4/3/23. PUB 745 was not observed posted and LIC 610D needs to be update to current version. Last fire drill was provided on 4/3/23. Facility has fire sprinkler system and smoke/carbon monoxide detectors throughout. Fire extinguishers were observed and last checked in Jan. 2023. Deficiencies were noted on LIC 809D per Title 22 regulations. Exit interview was conducted with D'arolyn Acevedo and a copy of this report, LIC 809D, and appeal rights were provided.