Routine inspection·September 26, 2024

Licensing Program Analysts (LPAs) Gary Tan and Angelica Segovie conducted an unannounced Required One (1) year visit at this facility. LPA met with Florence Peregrino, facility administrator designee and explained the reason for the visit. There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The screen door however has a broken handle. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside and inside. 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 visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. At 12:52 PM, tour of the physical plant was conducted with the staff. This facility is a single storey house and has five (5) bedrooms and two (2) bathrooms currently occupying three (3) residents. One (1) bedroom is designated for staff use. The facility is fire cleared for six (6) ambulatory residents, four (4) of which may be ambulatory and one (1) maybe bedridden in Room #5, hospice waiver for six (6) residents. 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 the dining room. The facility maintains a comfortable temperature at 74°F. The smoke detector is hardwired, tested and observed to be operational. There are two (2) fire extinguishers located in the kitchen. Both extinguishers are observed to be full and last checked on 06/03/24. There is carbon monoxide detector installed at the facility. (continued on LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. There is a shed located in the other side of the backyard currently being used as an old equipment storage and inaccessible to residents. 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, laundry detergents, pesticides or toxins were stored in the kitchen cabinet and observed to be locked and inaccessible to residents. All sharps and knives were also observed to be locked in a kitchen cabinet. At this time, there is no laundry or dryer machine at the facility. Per the designee, it was taken a week ago and no delivery yet to date. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit to non-private rooms. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Rooms: Staff room was observed to be locked. No medications are observed in the staff room. 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 108.2°F to 117.3°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications : LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There are two (2) complete first aid kits located in the medication cabinet. Client and Staff records all residents and staff present records were reviewed. Residents and staff record appeared to be complete and updated. Disaster drill was last conducted on 08/15/24. Required posting are observed to be complete and current and displayed properly at the facility. Citation issued. Appeal rights discussed and given. Exit interview conducted and copy of this report issued.