Routine inspection·August 29, 2022

Licensing Program Analyst (LPA) V. Maldonado conducted an annual required inspection at the facility. LPA Maldonado met with staff Eufrosino De Casa (cook) and explained the reason for the visit. Shortly after, the administrator Evangeline De Casa arrived and assisted with the visit. LPA used the infection control tool to evaluate the facility. During today's visit, LPA observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. The facility has submitted a mitigation plan and approved on 7/26/2021. The facility consists of (10) resident bedrooms and (8) bathrooms on address 10337 and (4) residents bedrooms and (2) bathrooms on address 10329 (2) , dining areas, living room/TV area , outdoor activity areas, smoking area and garage w/ laundry area. LPA toured the entire facility and observed 8 out of the 14 bedrooms including rooms# 5, #7-#12, and #14. LPA observed bathroom # 1, #2, and #5 on address 10037 and bathroom#1 on address 10329. All bathrooms toured were observed to be clean, fully stocked with hand soap, and paper towels, and had the required grab bars and nonskid mats in place. All showers in bathrooms accommodate non-ambulatory clients. The hot water tested between 114.8*F - 119.2*F in all bathrooms. All rooms toured were observed to have the required linens and furniture were in good repair. Adequate lighting and closet space was observed in all rooms. LPA also observed adequate perishable, non-perishable, and emergency food supply at time of the visit. All sharps were observed to be stored in a kitchen cabinet, which has a locked door to the entrance. Outside grounds were toured. Backyard was free of debris, exit ways and pathways were clear of hazards. Several fire extinguishers near entrances/exits and in the hallways were observed to be fully charged and have recent inspections. The smoke and carbon monoxide detectors were tested and observed to be functioning, during today's visit. Additionally, sufficient PPE supplies were observed stored in the garage and readily available in common areas for the residents to use. Medication was observed to be centrally stored in a separate room in address 10337 and all cleaning supplies/toxins were stored in a cabinet in the hallway. (Report continued on LIC809-C...) LPA reviewed 4 resident files to confirm emergency contacts are updated. LPA also reviewed 3 staff files to confirm health screenings and fingerprint clearances. LPA reviewed 4 residents' medications. At 11:25 a.m., LPA Maldonado observed one of the resident's medication box on top of the counter in the dining room- easily accessible to other residents in care. When staff was asked about it, it was stated that the resident had just received their medication and immediately took the medication to store it away. Deficiencies were observed during today's visit and will be cited per Title 22, Division 6, Chapter 8. Refer to the LIC809-D page for the deficiencies cited. An exit interview was conducted with administrator Evangeline De Casa and a copy of this report and appeal rights were provided.