Routine inspection·January 22, 2024

On 01/22/2024 at 9:20 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct a Required Annual Inspection. LPA was greeted by caregiver Jenny Franoso who granted access. Jenny asked LPA to sign in. Jenny called the administrator Jojo Cajayon and LPA explained the reason for the visit. Jojo could not meet LPA at the facility for todays visit, Jojo designated Jenny to sign today's report. The inspection tool was used to complete this visit. At the facility LPA observed two caregivers Jenny and staff #1 (S1). At 9:35 a.m. LPA began a physical plant tour of the facility and the following was observed: Dining / Living Area: LPA observed required postings by the facility entrance. The dining and living area were clean and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the living area was not in use and secured with a glass screen. In the hallway by the dining area, LPA observed the thermostat at a comfortable temperature of 76°F. Dining table was clean, clear of clutter and sits the capacity of the facility. The fire extinguisher was observed by the dining table fully charged last serviced on 05/26/2023. Kitchen: LPA observed the kitchen to be clean and clear of clutter. Cleaning chemicals are locked under the sink. Knives and sharps are kept locked in a kitchen drawer inaccessible to residents. LPA observed a 2-day perishable and 7-day non-perishable supply of food; properly stored. LPA observed a small refrigerator locked and used for storing medication requiring refrigeration and a second refrigerator by the dining table. LPA observed smoke detectors through out the facility that are interconnected and dual carbon monoxide. LPA observed S1 test the smoke/carbon detectors at 11:07 a.m. and it was observed to be functioning properly. (Continued to LIC809-C) Bedrooms: There are seven (7) total bedrooms six (6) bedrooms are designated for resident use. One (1) out of the six (6) rooms is currently vacant. All resident rooms are furnished with required lighting, chair, bed, and linens. Exit doors with auditory alarms where working properly. Bathrooms : There are two (2) bathrooms designated for resident use. Both bathrooms are accessible to residents by the hallway. Both bathrooms were well lit, clean, had grab bars, had hand washing signs, nonskid mats and trash bins with lids. LPA observed a sufficient supply of hand soup and paper towels. At approximately 11:07 a.m. the hot water temperature in one (1) out of two (2) bathrooms was tested and read 113.1 degrees Fahrenheit. Surrounding Grounds : Passageways were free from obstruction. Side gate was observed closed but unlocked. There is appropriate outdoor seating for residents with no shade. LPA observed one shed unlocked in the backyard. Shed is being used for storage and has a third refrigerator. LPA observed a hospital bed in the backyard according to administrator bed is scheduled to be picked up for removal. Resident and Staff files: At 10:15 a.m. LPA reviewed two (2) staff files for the staff present at time of visit and observed both files missing LIC 503 - Health Screening with TB screening. LPA contacted administrator at 11:50 a.m. according to administrator staff have required documentation, however it could not be provided to LPA at time of visit. LPA reviewed five (5) out of five (5) resident records and Resident #4 (R4) was missing a Medical Assessment/ Physician's report and admission agreement was not signed by the facility. Resident #3 (R3) was missing an updated annual medical assessment/ physician's report due to their dementia diagnosis. LPA contacted administrator at 11:50 a.m. to discuss missing and incomplete records. According to administrator they are working with resident's responsible parties to thoroughly complete records. Medications: LPA observed, resident medications locked in a small refrigerator in the kitchen and looked in a hallway cabinet inaccessible to residents. Medication and Medication Records were reviewed for proper documentation. Deficiencies cited (refer to 809D). Exit interview conducted. Appeal rights provided. Copy of report provided.