Routine inspection·April 13, 2023

Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection. LPA arrived unannounced and met with Staff Josie Alberto who allowed entry. LPA explained the purpose of the visit. Administrator Judy Ragano was contacted via mobile phone and the purpose for the visit was explained. The facility is licensed for 6 residents ages 60 and over. The fire clearance is approved for six ambulatory residents of which six may be non-ambulatory and 1 bedridden. There is a hospice waiver approved for 6 residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant & Environment Safety: There are 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, and an attached garage. Facility has operable smoke and carbon monoxide detectors located in each room and hallway. Knives, cleaning solutions, and disinfectants are locked in the cabinets. No firearms or weapons are stored at the facility. LPA measured the hot water temperature in the bathrooms and kitchen sink. The hot water temperature in the bathroom and kitchen were measured between 121.1 -122.5 degrees F which is not between the required range of 105-120 degrees. Staff adjusted the water temperature and LPA measured the temperature again during visit and it measured between 107.7 - 111.3 F which is within the required range. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. One resident did not have Pre-admission appraisal on file at time of visit. (Continued on 809C) Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Visiting hours were posted. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food is properly stored in the refrigerator to avoid cross contamination. Incidental Medical & Dental: The medications are centrally stored and in their original containers. During the visit today, LPA reviewed all 6 residents' medication and did not observe some PRN recording in resident’s file. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Due to time constraints, LPA will return another day to complete the rest of the inspection. Deficiency cited (See 809D) and technical advisory was also provided. An exit interview was held. A copy of this report, LIC809D, technical advisory note, and appeal rights were given to Staff Josie Alberto