Routine inspection·November 28, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 11/28/2023. LPA was met by Caregiver Queen Alimario and explained the purpose of the visit. The facility is licensed to serve six (6) non ambulatory residents over the age of 60. LPA OBSERVATIONS: The facility is a single-story dwelling located in a residential neighborhood and consist of four (4) resident bedrooms, one (1) staff bedroom, two (2) shared bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Front Yard: No hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to four (4) out of four (4) residents in care. Kitchen sink water temperature was measured at 117.3 degree F. Kitchen appliances were observed to be clean and in working order. LPA Ramirez observed several boxes stacked on top of each other in kitchen area. Dining Room/Living room/: Dining room was observed to contain one table with plenty of seating. Living room was observed to have plenty of seating and lighting. LPA Ramirez observed several boxes stacked on top of each other in various corners/areas of living room. Linen Closet: Contained plenty linens, towels, and hygiene products. see 809-C Resident Rooms 1 - 4: LPA Ramirez inspected four (4) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. Bedroom#1 is shared, bedroom#2 is currently unoccupied, and bedroom# 3 and #4 are shared. Bathrooms: Water temperature in bathrooms# 1-2 were within 105-120 degree F. Backyard: No hazards were observed. Plenty of shade and seating was observed. Emergency Drills: Staff could not provide documented proof if emergency drills conducted. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Personnel Records: Personnel records are maintained at facility. LPA Ramirez reviewed staff files for four (4) staff. Documented proof of required annual training was not observed. Resident Files: Four (4) resident files were reviewed. Original signed admissions agreements were not observed in resident files. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Ramirez observed updated infection control plan. Deficiencies and technical advisories are being cited. A copy of this report, 809-D, LIC 9120 and appeals rights was provided.