Routine inspection·October 24, 2024

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with backup Administrator Mariza Dulfo Chua and explained the reason for the visit. At approximately 12:35 pm, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. The fire extinguisher is located in the kitchen with a purchase date of 10/13/2024. Laundry Area: Laundry area is located at the far end of the kitchen. Appliances were observed to be in good repair. All the toxins, cleaning solutions, and disinfectants are locked in the pantry across from the washer and dryer. Bedrooms: The facility has seven (7) bedrooms. There were six (6) bedrooms designated for residents' use. One(1) bedroom is designated for staff. All Six (6) residents' bedrooms are designated for private use. All residents' bedrooms were properly furnished with appropriate bedding and linens with sufficient lighting. LPA observed there is a carbon monoxide detector that functions properly installed in the hallway between resident rooms. LPA tested smoke alarms and they were interconnected and battery-operated. Bathrooms: There are three (3) bathrooms: one (1) bathroom in the hallway near the front of the house, one (1) bathroom at the far end of the kitchen, one (1) in the private bedroom, and unused half bath as broom/mop/bucket holding area. Each bathroom has a posted “wash your hands” sign and the following items are available: hand soap, paper towels, and trash cans. The hot water temperature was measured at 116.6. No cleaning supplies or hazardous items were present in each bathroom during the inspection. (Continue on 809C) Medications: Medication and Medication Records were reviewed for proper documentation. Temperature: The facility maintains a comfortable temperature of 77 degrees Fahrenheit Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Medications were locked in a closet near the front door across from the kitchen. Medications were observed to be locked and inaccessible to residents. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. There is a covered patio and a large gazebo with a table and chairs for residents to use in the backyard. The patio furniture was observed to be in good repair. Garage: The garage is used for storage boxes, and equipment, and has an extra deep freezer for meats and poultry. Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. LPA observed that LIC 601, LIC 603, and LIC 625 are missing from R1, R2, R3, and R4 files. LPA also observed that R3 doesn't have an updated physician report for this year. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliant with licensing forms. LPA observed that S1 and S2 have expired CPR certificates. Exit interview conducted, citations issued, appeal rights given and copy of this report signed and delivered.