Routine inspection·January 7, 2024

Licensing Program Analyst (LPA) Gary Tan met with the Administrator Herman Javier for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. At 9:01 AM, A tour of the physical plant was conducted at 10:30am and the following was noted: There is only one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. Signs to wear a mask and other COVID 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated outdoor visitors' area located in the backyard. The facility has sufficient stock of PPE in a storage cabinet located in the hallway. The facility has seven (7) bedrooms and three (3) bathrooms. One (1) bedroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory and a hospice waiver for four (4). Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with dining The facility maintains a comfortable temperature at 74°F. The smoke detectors are hardwired and inter connected and observed to be operational. The facility is equipped with sprinkler system. The fire extinguisher was located in the kitchen and observed to be filled and current. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. (continued to LIC 809-C) (continued from LIC 809) Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies including detergents and pesticides and other toxins are stored in garage. Knives and sharps are observed to be kept in a locked drawer in the kitchen. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. The swimming pool is appropriately fenced and was observed to be locked during visit. The garage is attached to the home and was locked and inaccessible to residents during the visit. The garage is also used as a stock room for emergency foods and PPE and laundry area. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 112.5°F to 118.9°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications : LPA observed the medication cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. First aids kits have complete tools and supplies. Client records : Client records are reviewed. Three (3) out of six (6) residents had no physician's report on file. Staff records : LPA conducted a complete file review of staff record. Staff #1 (S1) has no fingerprint clearance. Two (2) staff had no first aid training certificate on file. Disaster drill was last conducted on 10/19/2023. Required posting are observed to be complete and current and displayed properly at the facility. Citation issued. Civil penalty assessed. Exit interview conducted and copy of this report issued.