Routine inspection·February 23, 2024

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the caregiver. The Administrator Stephanie Domingo arrived at 10:00 am. LPA stated the purpose of the visit was to conduct an annual inspection. The Administrator confirmed there are five residents living in the facility. The facility is licensed for six (6) non-ambulatory residents. Two (2) of the six (6) can be bedridden residents. LPA Spaeth and the Administrator toured the facility at 10:15 am until 11:00 am.. Common Areas – The family room, dining room, and kitchen are combined. The family room was furnished with comfortable seating and a television. The dining room contained a dining room table and chairs. Medications: LPA observed the resident medications, first aid kit, and PPE supplies were safely locked in a kitchen cabinet. Kitchen – LPA observed a two day supply of perishable food and a seven day supply of non-perishable food items. The fire extinguisher was located near the kitchen and was operable. The Administrator opened a kitchen cabinet but observed the lock using a magnet did not properly work. LPA stated to the Administrator that a secure lock will need to be installed. Cleaning solutions were locked underneath the kitchen sink. Laundry Room – The laundry room door has a key-punch lock system. The door was slightly opened and was not securely locked. LPA observed the washer/dryer and the laundry detergent. Continued on 809-C Garage –The garage was locked. The staff room is located within the garage area. Resident Rooms: There are four resident rooms which were furnished with a bed, linens, night stand, lamp and chair. The rooms were neat and clean. LPA Spaeth observed the resident rooms contain a sprinkler system. Bathrooms: There are three bathrooms in the facility. The bathrooms contained hand soap, paper towels, grab bars, and slip resistant mats. At 10:45 am, LPA observed a Lysol spray, cleaning solution stored underneath the bathroom sink and not securely locked. LPA Spaeth tested the water temperature in the bathroom located in a resident's room. The temperature was recorded to be 118.0 Degrees F. LPA observed the clean linens were located in a cabinet within the staff bathroom. Surrounding Grounds : There were no visible hazards, and passageways were free from obstruction. The side gate of the house was closed and was not locked. Comfortable seating is also located in the backyard. Smoke/Carbon Monoxide Detectors : The smoke/carbon monoxide detectors were tested at 10:55 am and were operable. LPA reviewed resident files at 11:00 am until 11:50 am. LPA Spaeth observed resident 1 and resident 5 did not contain the Physician's Report. LPA reviewed staff records at 11:50 am until 12:20 pm. LPA viewed a resident's medication at 12:20 until 12:30 pm. Based upon LPA's observations and based upon Title 22 Regulations, the following deficiencies are substantiated. (See 809-D page). Exit interview conducted, appeal rights discussed, and a copy of the signed report was given.