Routine inspection·August 8, 2022

Licensing Program Analyst (LPA) Shira Stamps met with designee Shella Villar for an unannounced one (1) year Required visit for this facility. LPA arrived at 10:30am and was greeted by caregiver Shella Villar. The Administrator was contacted at 10:40am, and LPA spoke to the Administrator and informed her of the purpose of the visit. The Administrator was out of town over 45 minutes away, and designated caregiver Shella to sign the report. One (1) resident was observed in the living room resting. The rest of the residents were observed to be in their room sleeping, watching TV and/or resting. A tour of the physical plant was conducted with the Designee at 10:53 am. The facility has six (6) bedrooms and two (2) bathrooms currently occupying five (5) residents. One (1) bedroom and one (1) bathroom is designated for staff use only. The facility is Fire Cleared for five (5) non-ambulatory and one (1) bedridden. Infection control: LPA reviewed facility mitigation plan (approved on 03/13/21) to make sure licensee was following current infection control recommendations. Upon arrival LPA was screened by the caregiver and asked all infection control questions. LPA was asked to sign-in and sanitize/wash hands. Food Inspection LPA conducted tour of the kitchen around 10:55 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed a child squeeze lock on the cabinet under the kitchen sink. The cabinet obtained three (3) bottles of chemicals/ cleaning solutions and disposable needles. The Designee immediately locked the hazardous items in the garage. LPA observed all knives and sharp object being locked and inaccessible to residents in care in the locked hallway closet along with the resident’s medications. CONTINUED... Living and dining LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 72°F. The dual smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:15 am. There is one (1) fire extinguisher located in the kitchen. The Fire extinguisher was observed to be full and last serviced on 09/15/21. Laundry/Garage LPA observed the garage to be attached to the facility and currently being used for the laundry room, extra food storage, chemicals, and general storage. The garage remains locked at all times. Resident Rooms LPA observed rooms to have the appropriate bedding. There is a night stand and sufficient lighting for each resident. LPA tested the exit doors auditory system and it was observed to be operational. Bathrooms At 11:11am LPA observed all bathrooms to have non-skid matts, grab bars, and the appropriated wash your hands signs posted. Hot water was tested at 11:35am and measured within regulation at 115.0 degrees F. Physical environment LPA toured the outside area of the facility at 11:15pm. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. No bodies of water on the premises. Administrative: LPA collected the LIC.500 and resident roster. Annual fee is due 8/26/22. LPA reviewed resident record for room #4 to ensure resident is non-ambulatory and verified with physician report. Infection control plan has not been received, and LPA informed the Administrator to send the plan. An exit interview was conducted over the phone with the Administrator. Citation issued, and appeal rights and copy of this report was given for the Administrator.