Routine inspection·April 5, 2024

At 10:00am Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Huma Rahimi conducted an unannounced annual inspection at the facility mentioned above. LPAs met with facility staff Karen Villagracia and the facility administrator Joanne V Jocom who arrived later. At approximately 10:10am physical tour was conducted with the staff, LPAs observed the following: The facility is approved for six (6) ambulatory residents, of which five (5) may be Non-ambulatory- with designated bedrooms #2, #3, and #4. Facility has Hospice waiver for six (6) residents. Kitchen : At approximately, 10:15am LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. Canned non expired food was stored in kitchen cabinets. LPAs observed knives and toxins locked under the kitchen sink; however, one of the knives was observed unlocked in the kitchen drawer. The facility has a working gas stove, microwave, refrigerator and freezer. Bedrooms : At approximately 10:20am LPAs checked the bedrooms. There are four (4) bedrooms designated for 4 residents use. All rooms were observed to have sufficient lighting, and are properly furnished, clean and have appropriate bedding and linens. There is enough linens to be change every week or when necessary in a cabinet in the hallway Bathrooms : At 10:30am LPAs observed two (2) bathrooms, all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. Hot water was measured at 111.9 F. Bathroom # two (2) is designated for staff use only and locked not accessible for resident's use. LPAs observed appropriate grab bar and had non-skid mat. All trash cans in bathrooms had fitted lids to protect from cross contamination. Continue on LIC 809C Medications : At approximately, 10:35am LPAs observed medications are centrally stored and locked in the hallway closet on the top shelves. Resident and staff records also stored in locked hallway closet. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the resident's doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. The laundry room: is located in the hallway without any locking mechanism. LPAs observed all detergents were unlocked and accessible to residents in care. Common Areas : The facility maintains a comfortable temperature at 71°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility found. Dual smoke supplies were tested and carbon monoxide detectors were located throughout the facility and observed to be operational. No issue with fire clearance. There is a functioning telephone/landline on the premises. An emergency exit plan/sketch is posted near each entrance/exit wall with other posting requirements. There is a fire extinguisher by the kitchen area were last purchased on 01/20/2024. Outside areas: At approximately, 10:50am LPAs toured the outside area of the facility. Exit area is free of obstructions and hazards. LPAs checked inside of the locked basement storage where enough PPE supplies were stored, and it was used for facility maintenance purposes. LPAs discussed the importance of maintaining the care and supervision to meet the needs of residents. The facility does not have a swimming pool or body of water. There is no garage only parking port. Between 11:00am to 1:00pm, LPAs reviewed records of four (4) clients and four (4) staff. Clients and staff records appeared to be complete and updated. Administrative : LPAs collected Administrator Certificate, infection control, LIC 500, LIC 9020. Citations issued during this visit. Appeal rights explained. Exit interview conducted. Copy of report printed and handed to Licensee.