Routine inspection·August 4, 2022

On 08/04/2022, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA was met by caregiver Myrna Dennis and Nestor Villena and was later joined by Administrator Kenneth Soleta and explained the purpose of today’s visit. The facility is licensed to serve six (6) elderly residents ages 60 and above.. The facility has a hospice waiver for two (2) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident's rooms, two (2) staff rooms, three (3) bathrooms, living area, dining area, kitchen, and outside shaded patio area covered with a canopy and ample seating in backyard. All five (5) residents were in the facility at the time of the visit. LPA and caregivers Myrna Dennis and Nestor Villena toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were operational. The water temperature did not meet Title 22 regulations and are cited on the D page. There is a car port located at the rear of the house and is accessible through the alley in the back yard which is gated. There is also a second freezer located in the staff room for extra frozen food. Evaluation Report Continues on LIC 809-C LPA observed the facility to be appropriately furnished at the time of visit. LPA observed cleaning supplies and toxins not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available and properly maintained. There are two (2) fire extinguishers fully charged in the kitchen area. Smoke detectors and carbon monoxide were tested and operational. A review of Medication Administration Records (MAR) was maintained in order and accurate. There was a first aid kit available stored in the kitchen. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed all mandated inspection control posters were posted. Advisory Notes – Three (3) Technical Assistance were issued, please see LIC9102-AN. There were two deficiencies cited during this inspection visit. See 809D page. An exit interview was conducted and a copy of this report was provided to Administrator Kenneth Soleta.