Pre-licensing visit·October 2, 2023

On 10/02/23 at 9:00am, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an announced Prelicensing visit to the facility listed above. LPA met with Administrator/Licensee, Zenaida Malabunga, and explained the purpose of today's visit. An applications was submitted for a change of ownership. Currently there are 4 residents living at the facility, 1 resident is ambulatory and 3 are nonambulatory. Structure/Physical Plant The facility is a single story home in a residential neighborhood. The home consists of four (4) bedrooms, two (2) bathrooms, kitchen, dining room, living room, attached garage, and front and backyard. The backyard has a shaded patio with chairs and table. The front and backyard are landscaped and in good repair. All ramps have secured handrails. All walkways outside were clean, clear, and free of obstructions, debris, and hazards. There are no bodies of water on the premises. Bedrooms LPA inspected all resident bedrooms. LPA observed all bedrooms to have a bed, dresser, nightstand with lamp, chair, and ample storage space for resident use. All beds had the required linens, including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of bed linens stored in a cabinet in the hallway and an additional supply in the residents’ closets. All bedrooms were observed to be in good repair. Bathrooms LPA inspected all resident bathrooms. All bathrooms were found to be within Title 22 regulations. All bathrooms were observed to be operable. The showers were observed to be clean, and clear of mold or mildew. Both showers had secured safety handrails, nonskid matts, and shower chairs available. The water temperature measured 111.4-degrees and 110.3-degrees Fahrenheit. LPA observed hygiene products secured in a cabinet under the sink and are inaccessible to residents. An additional supply was observed secured in a cabinet in the garage. LPA observed an ample supply of towels in a cabinet in the hallway and an additional supply stored in each residents closet. Kitchen LPA inspected the kitchen and found it to be clean and sanitary. LPA observed all appliances, including stove, oven, refrigerator, dishwasher, and microwave, to be in good working repair. LPA observed an ample supply of cutleries, pots, and pans to be in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. All food was observed labeled, and properly stored. Continued on LIC809-C All sharps are secured in a locked drawer in the kitchen and are inaccessible to residents. The water temperature measured 109.4-degrees Fahrenheit. LPA reviewed the sample menu posted in the kitchen. Common Rooms LPA inspected all rooms. The dining room has a large table with chairs to accommodate all residents. The living room has a couch and chairs to accommodate residents. LPA did observe a fireplace that is screened, locked and inaccessible to residents. LPA observed games, puzzles, books, and magazines available for residents. All rooms were observed to have ample lighting. All walkways were observed clean, clear, and free of obstructions and hazards. The facility was maintained at a comfortable temperature. Medications/Files LPA observed all Centrally Stored Medications secured in a locked cabinet in the dining room, inaccessible to residents. LPA reviewed the Medication Administration Record (MAR) log that is used to record medications given to residents. LPA observed staff and resident file stored in a locked file cabinet in the dining room and are inaccessible to residents. Safety LPA observed two (2) fully charged fire extinguishers lasted serviced on 03/06/23. One extinguisher was mounted in the kitchen and the other was mounted in the garage. The smoke/carbon monoxide detectors are hardwired and fully operational. All rooms have an emergency exit sketch posted with the exit route marked. LPA inspected the First Aid Kit and found it contained all the required items and manual. The door leading to the hallway where the bedrooms are located and the door to room 2 (bedridden room), are fire doors wired to the smoke detector system and if they are set off the doors close automatically. The facility has an alarm system that informs staff a door is opened and identifies which door is opened. The facility has a working landline telephone. LPA observed all required state posting throughout the facility. Infection Control During today’s visit, LPA observed the facilities infection control practices. At the entrance and throughout the facility, there are sanitizing stations. LPA observed all staff wearing a face mask. LPA reviewed the visitor sign-in logs where temperatures are recorded. LPA observed Infection Control signs posted throughout the facility. LPA observed a 30-day supply of PPEs stored in the garage. Component III was reviewed and discussed with Licensee. LPA has no recommendations and did not observed anything that needs changed An exit interview was conducted with Licensee/Administrator, Zenaida Malabunga and a copy of this report was provided.