Routine inspection·August 28, 2023

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Eufrosino De Casa/Caregiver and Rodolfo Macalinao/Caregiver and explained the purpose of the visit. Administrator Evangeline De Casa arrived at shortly after and assisted LPA with the inspection. The facility is licensed to serve for 16 ambulatory and 4 non ambulatory residents age 60 and above. There are sixteen (16) residents currently living in the facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station and PPE supplies located near the front door. The staff use disposable gloves to clean and disinfect the high touched surfaces in the common areas. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Facility has some COVID-19 signage posted throughout the facility. Bathrooms have hand washing signs, soap and paper towels. Staff are adhering to infection control requirements. Operational Requirements: A current Plan of Operation was reviewed. The updated Infection Control Plan has been submitted to CCL. Liability Insurance policy is valid and will expire on 01/24/2024. Surety Bond is in effect and in force with bond amount of $5000. Last Fire/Disaster Drill was last conducted on 07/03/2023. Physical Plant/Environment Safety: 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, laundry room, storage room, detached garage and backyard. LPA toured the entire facility and observed all fourteen (14) residents bedrooms and one (1) staff bedroom. LPA observed that the bathroom sinks in bathrooms #2, #4, #6-#10 on address 10337 were clogged and not draining properly. 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. LPA observed a can of bug/insect killer spray under the sink in bathroom #1 which was unlocked and accessible to residents. Administrator took the bug spray immediately and kept it in a locked cabinet. All showers in bathrooms accommodate non-ambulatory clients. The hot water tested between 109.5*F - 115.8*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. However, LPA observed that the facility did not have an operational signal system in the resident rooms (bedrooms #8-#10 and bedrooms #11-#14) with exit doors leading to the side yard and backyard. All sharps were observed to be stored in a kitchen cabinet, which has a locked door to the entrance. Backyard was inspected and has a shaded area and sitting area. LPA observed clutter and miscellaneous unused items in the side yard and backyard. There were seven (7) fire extinguishers observed in the facility mounted on the walls in several areas of the buildings. Fire extinguishers were last inspected on 01/25/2023. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. Additionally, sufficient PPE supplies were observed stored in the garage and readily available in common areas for the residents to use. *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of twelve (12) staff members including the Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Personnel Records-Training: LPA reviewed four (4) staff files and confirmed health screenings and fingerprint clearances. Proof of staff training, health clearance, vaccinations and 1st Aid/CPR training are current. Administrator certificate is valid and expiring on 11/08/2024. Administrator has a valid HIV/AIDS training proof at the time of visit. Resident Records-Incident Reports: LPA reviewed resident files for R1-R5. Resident files are maintained at the facility. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Client Cash Resources, Appraisal and Needs Service Plan, Special Incident Reports, Resident Personal Property and Resident Personal Rights observed. Resident Rights-Information: Resident personal rights are posted. Per Administrator, facility provides internet services to all residents and have access to the facility phone. Planned Activities: Planned activities are made available to residents. Facility provides equipment and space to accommodate both outdoor and indoor activities. Weekly activities had been developed. Food Service: There are sufficient food supplies of 2-day perishable and 7-day non-perishable items. The food is properly stored in the refrigerator (clean and well maintained). There are three (3) residents with special diet/diabetic diet residing at this facility. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Incidental Medical Services : Medication was observed to be centrally stored in a separate room in address 10337 and all cleaning supplies/toxins were stored in a locked storage room next to the detached garage. LPA reviewed 4 resident files to confirm emergency contacts are updated. Medications were reviewed for R1-R5 to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. Medications are bubbled packed. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan. Residents with SHN: Not-Applicable. Deficiencies cited on LIC 809D. Exit interview, appeals rights and a copy of this report was provided to the Administrator, Evangeline De Casa.