Routine inspection·May 19, 2023

On 05/19/2023 at 10:05 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the above mentioned facility to conduct an unannounced required annual inspection. LPA met with caregiver Luis Medina who granted access. Luis contacted Administrator James Durando at approximately 10:10 a.m. by phone, James reported he would not be able to meet LPA at the facility. James designated Luis to sign todays report(s). Personnel summary report was verified, and staff was cleared to work in the facility. The total capacity is (6), and the current census is (4). Present at the facility was caregiver Luis and resident #1 (R1). Three (3) residents were at day program. Administrator certificate posted and valid and current until November 01, 2023. Facility has an approved Infection Control plan as of 03/21/2021. At approximately 10:26 a.m. LPA and Luis conducted a physical plant tour of the inside and outside of the facility and the following was observed. Kitchen: LPA observed knives, a fully stocked first aid kit and PRN for one of four residents stored in a locked cabinet above the refrigerator. Cleaning supplies were on the counter and Luis explained he was cleaning when LPA arrived. Cleaning chemicals and detergents are kept in a locked laundry space located in a hallway when not in use with the washer and dryer. LPA observed there to be an insufficient amount of 2-day perishable and a 7-day non-perishable food supply in the kitchen for the residents in care. Luis explained most residents are at day program and grocery shopping is done every Monday or when needed. LPA observed expired shredded lettuce in the refrigerator and expired pancake mix, and expired stove top cornbread in the pantry. Luis removed and trashed the expired food immediately and said he would address it with the rest of the staff. Fire extinguisher located by the kitchen was observed to be fully charged, with last service date of 04/10/2023. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting. (LIC809-C continued on to next page) Dining table was clear from clutter and had seating for the four residents. Bedrooms: Facility has (5) bedrooms, one (1) bedroom is shared and is vacant. Resident's bedding and linens were in good repair and bedrooms are appropriately furnished. Bathrooms: There are (2) bathrooms both observed to have toilet paper, hand soap, pull up bars and shower mats. Hot water measured at 110.1 degrees Fahrenheit. Personal hygiene products are available for residents. Surrounding Grounds: There were no visible hazards, or bodies of water and passageways were free from obstruction. Exit side gate was easily accessible. Carbon monoxide detector was tested at 10:42 a.m. and operating properly. Smoke detectors had a green light on indicting they have power. Staff and Resident Interviews: At 11:18 a.m. LPA interviewed R1 and it was revealed they have developed a wound and according to R1 they are not in pain. Medications: At approximately 11:50 a.m. LPA and Luis reviewed medications and Centrally Stored Medication records for four (4) out of four (4) residents. Medications are bubbled wrap and refilled automatically by the pharmacy. Garage: LPA did not have access to the garage. At 12:03 p.m. Luis contacted the Administrator and they explained garage access will not be available today because they are unavailable to return to the facility. Luis did not have a key at the facility to open the garage. LPA interviewed Administrator about R1's wound and Administrator explained R1 has been seen by a doctor and was referred to a podiatrist but at this moment does not have home health agency providing care to the wound. LPA asked Administrator where staff and resident records may be located. Administrator stated records should be in a cabinet in the dining room. Resident and Staff Records: At 12:05 p.m. LPA and Luis attempted to locate resident and staff files but were unsuccessful. LPA was only able to locate Emergency ID information for three (3) out of four (4) residents. LPA was unable to review facility records. Deficiencies cited (refer to 809-D). Exit interview conducted and copy of report and appeals provided.