Routine inspection·May 30, 2025

On 05/30/2025 Licensing Program Analyst (LPA) Evelin Rios conducted an Annual Required visit and inspection of the facility. The inspection tool was used for todays visit. LPA arrived to the facility and was greeted by staff #1 (S1) who granted access. LPA met the administrator shortly after and explained the reason for the visit. LPA conducted a physical plant tour at 1:17 p.m., and LPA observed the following: At entry LPA observed appropriate postings on the wall near the front door and the hallway leading to residents' bedrooms. Kitchen: In the kitchen LPA observed the kitchen to be clean and clear of clutter. Appliances and fixtures were functional. LPA also observed a 7 day supply of non-perishable amount of food and a 2 day supply amount of perishable food in the facility. LPA observed a second staff, staff#2 (S2) in the facility. LPA observed cleaning products locked in a cabinet under the kitchen sink. Bedrooms: LPA observed a total of five (5) bedrooms designated for residents' use. One (01) bedroom may be shared. Resident bedrooms were observed clean and clear of clutter, properly furnished with appropriate beds, night stands and chairs. Doors in bedrooms leading to the outside had auditory alarms that were observed functional. LPA observed night-lights through out the facility. Bathrooms: There are three (03) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. From 1:32 p.m. to 1:35 p.m. LPA took the hot water temperature from two (02) out of three (03) bathrooms and they measured between 114.6 and 118.1 degrees Fahrenheit, within regulation. ( Continue on LIC809-C) Common Areas : These included living room, and the dining area. The common areas were properly furnished. The dining area has a table with chairs to sit the capacity of the facility. The living room has a television with seating that was observed in good repair. LPA observed activities and games for the residents. Outside/Surrounding Grounds : LPA observed that the entry/exits were free of obstruction. There is a shaded area for residents to use and furniture appropriate for outdoor use. The backyard has a enclosed patio that offers shade for residents. The patio area is sufficient in space for outdoor exercise and activities. There is a fish pond not in use closed and locked with wood and grate. Laundry/Garage: The laundry room leads to the attached garage. The door to the laundry room was observed locked. Cleaning supplies and detergents are kept locked in the garage. The garage is used for facility storage. Smoke detectors/carbon monoxide . All resident rooms are equipped with smoke detectors and the facility's smoke detectors are hard wired and interconnected. The carbon monoxide detector is located in a hallway leading to bedrooms. Detectors were tested by licensee at 1:35 p.m., and were observed operational. A fire extinguisher located by the kitchen was observed fully charged with service date 04/10/25. From 1:37 p.m. to 2:30 p.m., LPA reviewed three (03) of three (03) resident records and (3) staff records. Records were observed locked in the medication cabinet. Two (02) out of three (03) staff records reviewed did not have health screenings completed with TB test conducted prior to providing care in the facility. LPA collected a copy of the Certificate of Liability Insurance. LPA reviewed administrator certificate, infection control plan and LIC610E. LPA reviewed residents' centrally stored medication and medication records. LPA observed medications are centrally stored and locked in a closet. LPA observed a complete first aid kit in the closet. One (01) out of the (03) residents medication records reviewed did not have a signed, dated written order for PRN medications from a physician on file. Deficiency cited during today’s visit (refer to LIC809-D). Exit interview conducted. Licensee was unable to stay for the duration of the visit and designated Arlina Jarin to sign todays report. Copy of appeal rights and report provided to .