Routine inspection·December 23, 2024

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit on 12/23/2024 and was greeted three caregiver at 10:00 am. LPA stated the purpose of the visit was to conduct an annual inspection. The caregiver confirmed there are five residents. The facility is licensed for a total of six non-ambulatory residents of which two can be bedridden. The Administrator, Stephanie Domingo arrived at 11:00 am. LPA Spaeth and the Administrator toured the location at 10:00 am until 10:40 am. Common Areas – LPA observed the family room, kitchen, and dining room are combined. The family room contained comfortable seating and a television. The dining room section contained a dining room table and chairs. Kitchen – LPA observed a two-day supply of perishable food and a seven-day supply of non-perishable food items. The medications are locked in a kitchen cabinet. The knives were locked in a kitchen drawer. A fire extinguisher was located in the kitchen area. LPA observed a resident's medication is stored in the refrigerator but is not locked in a safe location. Staff Room - LPA observed the staff was not locked but there were no safety hazards located in the room. Laundry Room – The laundry room was locked and contained washer/dryer, laundry soap, and cleaning solutions. Hallway – Clean linens are stored in cabinets. Continued on 809-C Garage - LPA observed the garage was locked. An additional freezer is located in the garage and contained additional frozen food items. Resident Bedrooms - There are four resident bedrooms which are furnished with a bed, linens, night stand, chest of drawers and a closet. Two residents are currently residing in the master bedroom (Bedroom #3) . Bathrooms – There are two bathrooms in the facility which contained hand soap, paper towels, slip resistant mat, and a trash can. Water Temperature - LPA tested the water temperature at 10:30 am which was 112.0 degrees F. Backyard - Comfortable outdoor seating is provided for the residents. The side gate leading from the backyard to the front yard was not locked. Smoke/Carbon Monoxide Detectors – The detectors were tested at 10:50 am and were operable. Medications - LPA observed the medications are locked in a kitchen cabinet. Auditory Device - At 10:25 am, LPA observed there was not an auditory device when exiting the master bedroom (#3) to the backyard. LPA reviewed residents' records at 11:00 am until 11:45 am. LPA reviewed staff records at 12:15 pm until 12:40 pm LPA reviewed resident medications at 1:00 pm. There were no issues when reviewing the records. Based upon the Title 22 regulations, the following deficiencies have been issued. Exit interview conducted, appeal rights discussed, and a copy of the report was given.