Routine inspection·November 26, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 11/26//2023. LPA was met by Administrator Jasbindar Singh and explained the purpose of the visit. The facility is licensed to serve six (6) non ambulatory residents over the age of 60 and has an approved hospice waiver for four (4). LPA OBSERVATIONS: The facility is a single-story dwelling located on a main street with three (3) resident bedrooms, two (2) staff bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Front Yard: Was clean and well maintained. LPA Ramirez observed gate that leads to backyard to be wide open. 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. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located nearby kitchen hallway cabinet, to be accessible to four (4) out of four (4) residents in care. LPA Ramirez observed a sign posted on cabinet door indicating to “lock cupboards at all times”, a pad lock was observed but not secured. Kitchen sink water temperature was measured at 114.2 degrees F. Kitchen appliances were observed to be clean and in working order. Two cabinet doors located by sink were in disrepair. Cabinet drawer containing paper items was loose and not opening correctly to its original design. LPA could see exposed nails. Upper cabinet door containing resident plates, cups and other dishware, was missing doorknob. Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. Nearby thermostat was observed to read 78 degree F. Linen Closet: Contained plenty linens, towels, and hygiene products. SEE 809-C Resident Rooms 1 - 3: LPA Ramirez inspected three (3) resident bedrooms and observed all bedrooms to contain required furnishings, lighting, and linens. Auditory device located on resident#2 exit door that leads to back yard, was observed to be in “Off” position. Administrator Singh placed device in “On” position after LPA Ramirez expressed concern. Bathrooms: Water temperature in both resident bathrooms were within 105- 120 degrees F. Bathroom #2 located near laundry room was observed to have 6 x 6 gap in flooring. LPA touched flooring and wood felt soft and wet. LPA Ramirez observed wall near outside shower tile to be stain with brownish-yellow stains, dry wall was peeling and cracking on both sides. Backyard: Was clean and well maintained. Plenty of shade and seating was observed. LPA Ramirez observed back yard gate to be wide open. Emergency Drills: Last documented drill was conducted on 11/11/23 at 3 pm. 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 three (3) staff. Resident Files: Four (4) resident files were reviewed. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Ramirez observed updated infection control plan. Laundry Room: LPA Ramirez observed laundry room door to be wide open and access to bleach and laundry soap were observed. LPA Ramirez observed two (2) back doors near laundry room, to have auditory devices switched in “OFF” position and doors were observed to be wide open. Deficiencies are being cited and a copy of this report, 809-D and appeals rights was provided.