Routine inspection·July 22, 2023

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Raul Cruz, Caregiver and explained the purpose of today's visit. Administrator is currently out and will not be able to assist LPA. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance lobby. The facility has not submitted an Infection Control Plan. Facility has COVID-19 signage posted in the facility. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements. Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has not been added to the Plan. A Hospice Waiver for 5 residents is approved. Liability Insurance in the amount of ($3,000,000) in total annual aggregate has expired on 3/20/2021 . Facility does not handle cash resources for the residents. The last fire Drill was conducted on 11/19/2020. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a single storey home located in a residential neighborhood. It is licensed for 6 non ambulatory, 1 of which may be bedridden. It consists of 5 resident rooms, 1 Staff bedroom/office, 3 full bathrooms, living room, family room, kitchen, dining room, attached garage and backyard. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Water temperature ranged between 108.5-118.6 degrees Fahrenheit. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cameras are operational and available outside the home and living room area only. Smoke and carbon monoxide detectors are operational. The facility has (2) fire extinguishers located in the kitchen which are both expired, and were purchased on 6/30/2022. Cleaning supplies and toxic substances are inaccessible to clients. *****CONTINUED ON LIC809-C***** Staffing: A total of two (2) staff members provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Administrator certificate expires 1/10/2025. Staff have criminal background clearance and training. Two (2) staff files were reviewed. Personnel records have health/TB screenings and First Aid/CPR training. Information regarding Dementia is part of the training for direct care staff and is included in the Plan of Operation. Resident Records-Incident Reports: A total of two (2) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, Individual Service Plans, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, and medication records. Resident Rights-Information: Resident personal rights are posted. Physician orders for use of full bed rails for one (1) resident was missing in the resident's files and unavailable for review. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. Facility does not have an activity calendar available nor posted in the home. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained).Pesticides and cleaning supplies are kept away from the food preparation areas. Plates, cups and utensils are kept cleaned and stored properly. Incident Medical and Dental: Two (2)centrally stored resident medications were reviewed; containing 30-day supply of medications. Medical and dental transportation is provided. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Records of resident Appraisal and Needs services plans are part of Emergency training.Fire Drill was last conducted on 11/19/2020. Residents with Special Health Needs: One (1) resident is receiving home health services. No one receives hospice care. Full bed rails for one (1) resident was missing and unavailable for review. "No smoking In Use" sign was not posted on the resident (R1) door. Pursuant to Title 22, deficiency was cited on the attached 809D and Technical Assistance were issued. An exit interview was conducted, and a copy of this report was provided to Raul Cruz, Caregiver.