Routine inspection·March 27, 2025

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Emerlinda Esguerra Caregiver and explained the reason for the visit. The facility is licensed to serve (6) elderly clients ages 60 and above with a hospice waiver for (3) residents. 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, front sitting area, and a back yard. LPA reviewed the following CARE inspection tool domains during this visit: Infection Control: Infection control plan was reviewed which meets current regulations. Hand sanitizer and proper sanitation was observed during the visit. One staff does not have a TB test clearance on file. There is a responsible person and emergency training was provided to staff. Personal protective equipment was observed. Operational Requirements: Facility maintains a plan of operation. Facility has a current liability insurance. Facility is operating within the license. Physical Plant/Environmental Safety: LPA conducted a tour of the facility with Emerlinda Esguerra and observed the following: Facility was observed in good repair indoors and outdoors. Living room/dining room are clean, and providing sufficient sitting area, and lighting. Kitchen area is clean, sharps were observed locked in a drawer. Medications were observed in a drawer unlocked. Cleaning supplies were observed unlocked. Laundry area was observed in good repair. (CONTINUED ON LIC 809C) Four (4) resident rooms were observed clean with sufficient lighting, furniture, and bedding supplies. Full bed rails were observed in bedroom #2. One (1) Bathroom was observed clean in working condition with grab bars and skid mats in the showers. Water temperature was tested at 105.8 degrees F., which is within the required 105-120 degrees F. Sun room was observed clean and furnished. Activities were observed in sun room. Front yard and back yard have a shaded seating area. Garage is used to stored additional food and cleaning supplies stored properly. There are no large bodies of water in the facility. Carbon Monoxide/Smoke detectors were observed, tested, and in working condition. Fire extinguishers were observed and last checked on 1/15/21. Ramps, exit doors, and passageways are free of debris and obstructions. Staffing: Administrator Ewa Knyczak arrived at the facility shortly after. Staff have current CPR/First Aid training on file. Night staff have been provided emergency training. Sufficient staff were observed. Personnel Records/Staff Training: Administrator certificate was observed for Ewa Knyczak #7006214740 exp. date: 9/22/26. All staff records were available for review. LPA reviewed a total of 4 staff files which included medical assessment, TB clearance, background clearance, and training. One (1) staff was missing a health screening/TB clearance. Staff training files were not on file for the last 20 hours of yearly training. Resident Rights/Information: Personal Rights, Let Us No poster (PUB 345), and Local Ombudsman posters were observed throughout the home. Planned Activities: Activity materials were observed. One (1) resident was observed involved in activities during the visit. Outdoor area has a seating area to promote outdoor activities. Food Service: Sufficient food supplies were observed of perishables for at least 2 days and non-perishables for at least 7 days. There are currently no residents on special diets. No pest was observed. Incidental Medical and Dental: There is an area designated to centrally stored medication in a cabinet with a lock in the kitchen. LPA observed some medications in unlocked kitchen cabinets. Medications are label and in their original containers. Resident Records/Incident Reports: Residents records were available for review. LPA reviewed a total of 5 resident files which contained medical assessment, TB clearance, admission agreement, an appraisal, a needs and care plan. Disaster Preparedness: Emergency Disaster plan (LIC 610D 3/19) was last reviewed on 3/15/25. Last Emergency drill was conducted on 3/1/24 quarterly emergency drills have not been conducted since last. (CONTINUED ON LIC 809C) Residents with Special Health Needs: Postural support/bed rails were observed and physician's request were observed in residents files under hospice. There are no residents with restricted health conditions under care. Facility is following dementia regulations. Medical assessments for residents with dementia were observed within the last 12 months. Auditory devices were observed in each exit door. Facility currently has two resident on hospice and keeps hospice plan on file. Deficiencies were noted per Title 22 Regulations and a technical violation was noted. Exit interview was conducted with Administrator and a copy of this report was provided.