Routine inspection·September 30, 2024

On 09/30/24, at 11:45 am., Licensing Program Analysts (LPAs) Gina Saucedo and Angelica Segovia arrived at the facility to conduct an unannounced, annual visit. Upon arrival, LPA met with caregiver Chris de Guzman and disclosed the purpose of the visit. The designee administrator was called and arrived about twenty-five (25) minutes later. LPA asked for the census, resident, and staff rosters. The facility tour started 12:50 pm Temperature of facility wall thermostat is observed and set to 71 degrees Fahrenheit. Medications -LPA observed medication stored in cabinet locked and secured in the kitchen area inaccessible to residents in the kitchen area. Kitchen area was sufficiently stocked with seven (7) days of perishable and seven (7) days of non-perishable food. Sharps are stored and locked in one of the cabinets in the kitchen on the right side of the sink. Toxins are kept secured and locked in one of the cabinets under the kitchen sink inaccessible to residents. There is one (1) fire extinguisher located against the wall in the kitchen area fully charged and dated August 2025. There were two (2) complete first aid kits stored in overhead cabinet in the kitchen. There is a backyard which has outdoor furniture and grassy area for outdoor activities. There is no pool. LIC 809C-continued The garage is attached to the house and was observed to be locked and used to store toxins, washer, and dryer. There is also one (1) refrigerator in the garage with extra food. Bedrooms: There is five (5) resident bedrooms. There are two (2) bedrooms that have their private bathroom and are single occupied. One (1) bedroom that is shared and the other bedroom that is single, occupied. All five (5) bedrooms are properly furnished with proper lightning. The bathrooms have proper toiletry and grab bars. There is one bathroom that is located by the entrance of the facility that is used by staff and residents. The bathroom temperature of the water are within regulations. It reads between 114.4-118 Fahrenheit. Living and dining room furniture is accessible for five (5) residents. There is a television, telephone line and enough seating for five (5) residents. Furniture was observed to be in good condition and there is no fireplace. The smoke/carbon monoxide detectors are hardwired and interconnected and were tested. They were functional. Administrative: There is an annual fee due which is due as of 11/2023 for $495.00. The Insurance plan is updated and expires on 07/2025, disaster plan, administrator certificate, Designation of facility responsibility, Admission Agreement, Personal Rights, Staff LIS and resident rights signs are against the wall at the entrance of the facility, Infection Control and Disaster Plan, Ombudsman. An exit interview was conducted, two(2) citations were issued, appeals rights and a copy of this report was given to the designee administrator.