Routine inspection·April 14, 2022

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control, food and medication review. LPA Flores met with Emerlinda Esguerra caregiver and explained the reason for the visit. Administrator Ewa Nyczak arrived 40 minutes later. he facility is a single story home located in a residential neighborhood and has 4 resident bedrooms, 2 bathrooms, a living room, a dining room, a kitchen equipped with a laundry area, a sun room, a detached garage, a front and back yard. No bodies of water were observed. LPA Flores conducted a tour of the facility with Emerlinda Esguerra Caregiver and observed the following: Kitchen area - LPA observed sufficient non-perishable foods for 7 days, and not sufficient perishables for at least 2 days. Medications were observed in refrigerators door compartment. Sharps were observed locked in a drawer by the sink, cleaning supplies were observed under kitchen's sink and cabinet not lock at the time of the visit. Medication was observed in kitchen drawer and on top of counter next to the refrigerator not lock. Resident bedrooms have sufficient lighting, bedding, and furniture required. Bedroom #2(BR2) and #3(BR3) were observed to have dry water patches about 2 feet long per administrator from repaired water leaks and popcorn ceiling was observed to be peeling. Full bed rails were observed for resident #1(R1), #2(R2), and Resident #3(R3), half bed rails were observed for resident #4(R4). R2,R3,R4 do not have a physician order on file for bed rails. Bathroom #1(B1) and #2(B2) were observed with skid mats, and grab bars, water was tested in B1 at 101.4 degrees F., and B2 at 104.6 degrees F. Cleaning supplies were observed next to the toilet in B1 and under the sink in B2. Auditory devices were observed not working in main entrance door and exit door with access to the backyard which leads to the driveway and main entrance, and not activated at the exit door in the kitchen. Smoke detectors were tested and in working condition. Fire extinguisher was observed in the kitchen wall. (CONTINUED ON LIC 809C) LPA reviewed medication and files for R1,R2,R3,R4. R2 and R4 had prescribed medications which did not have labels on or were not stored in original container. R1 did not have a current physician report. LPA reviewed 3 staff files. Administrator certificate was observed for Ewa Nyczak #6020655740 expiration date 9/22/22. Facility is screening visitors, staff, and residents but is not maintaining a visitors log. Staff were observed not wearing face coverings, N95 fit testing has not been done for staff, and signs have not been updated regarding visitation recommendations and hand washing guidelines. Deficiencies were noted on LIC 809D and technical advisories were given under Title 22 Regulations. Exit interview was conducted with Ewa Nyczak administrator and a copy of this report, LIC 809D, and appeal rights were provided.