Routine inspection·March 9, 2023

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit using the CARE tool at the facility. LPA met with Conrado Abaya - Caregiver and explain the reason for the visit. Administrator arrived 40 minutes later. The 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 covered front sitting area, and a back yard. Facility does not have large bodies of water. LPA Flores conducted a tour of the facility and observed the following: Facility is in clean and in good repair inside and out. Kitchen area was observed clean, sharps were located in a drawer to the left of the sink, cleaning supplies were stored under the kitchen sink, additional cleaning supplies were located in kitchen cabinet by doorway each area was unlocked during the visit. Medication was observed on the butter space of the refrigerator no lock was observed, and additional prescribed medication was observed to the left of refrigerator. Sufficient food was observed for residents for at least 2 days of perishables and 7 days of non-perishables. Dining room and living room were observed clean. Bedrooms #1-4 were observed and have sufficient lighting, furniture, and bedding supplies. Bathroom #1 and #2 were observed clean and in working condition with grab bars and skid mats. Water temperature was tested as follow: Water temperature tested at 110.3 degrees F. in bathroom #1 and 108.3 degrees F. in bathroom #2. Auditory devices were observed in main entrance and kitchen door and were off at the time of the visit. PUB 475 Complaint poster and Residents personal rights were not observed posted. LPA Flores reviewed (5) resident files and medication, resident #5(R5) is missing a physician report. LPA review (5) staff files and last training provided to staff was dated 7/18/21. Administrator certificate was review for Ewa Nyczak #6020655746 exp: 9/22/24. Liability Insurance was requested and it will be email to LPA by 3/10/23. Exit interview was conducted and a copy of this report, LIC 809D, and appeal rights were provided.