Routine inspection·February 13, 2024

On 02/13/24 at 11:30 a.m. Licensing Program Analyst (LPA) Evelin Rios conduct an unannounced annual inspection. LPA was greeted by staff #1 (S1). LPA observed hand sanitizer, and a visitor sign in log. LPA met with the administrator Emma Apolinario and Amante Apolinario. LPA explained to the administrator the purpose of the visit and an entrance interview was conducted. The facility is a two story home with a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident for a capacity of 6 residents. At approximately 11:32 a.m. LPA conducted a physical plant tour and the following was observed: Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of 2-day perishable and 7-day non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Medication was observed stored in a locked kitchen cabinet. Bedrooms: There are five (5) bedrooms designated for residents' use. Two (2) of the bedrooms are currently vacant. Bedroom #1 is shared. Rooms occupied by residents were properly furnished with appropriate beddings, linens and with sufficient lighting. LPA observed half bed rails on resident's #2 (R2's) bed. LPA observed half rails on resident #3 (R3) bed. Bathrooms: There is (1) bathroom designated for residents' use. Bathroom was properly supplied and had functional fixtures. Hot water temperature was taken 1:32 p.m. and read 117.8 degrees Fahrenheit. Common Areas : These included the living area and dining area. The common areas were clean and properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. (Continued to LIC809-C) The smoke alarms are interconnected. LPA observed a carbon monoxide detector in the hallway leading to the bedroom. Administrator tested smoke detectors at 11:33 a.m. and were observed to be functioning properly. The fire extinguisher is located by the kitchen observed fully charged with purchase date 08/02/23. Surrounding Grounds : The outdoor area was free of hazards and has a covered patio with outdoor furniture. LPA observed three sheds used for storage. Door leading to the garage was locked. LPA observed a deep freezer with food in a hallway. Detergents and cleaning products are kept in the laundry room inaccessible to residents. Resident Files : LPA conducted a file review of resident records to insure compliance of licensing forms at 12:00 p.m. LPA's record review for R2 revealed they had an order for bed rails. LPA's record review for R3, R3 did not have an order for bed rails. According to administrator R2 and R3 were on hospice at some point. Staff Files : LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. LPA did not observed current first aid and CPR certification for administrator or S1 who was assisting residents during today's visit. Review of S1's records revealed S1 is not associated to the facility. S1 is fingerprinted and background cleared and was at some point associated to this facility when it was going by a different name. LPA did not observe a transfer request on file. According to administrator S1 was just called in as a temp. Medications : At 1:00 p.m. LPA and administrator reviewed medication and medication records for proper documentation. Facility keeps Medication Administration Records (MAR) Deficiencies observed during the visit (refer to LIC809-D). Exit Interview Conducted. Appeal Rights provided. A copy of the report Issued.