Routine inspection·October 20, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required 1-year Visit on 10/20/2023 at 08:22 am. LPA was met by Caregiver, Lourdes Cruz and explained the purpose of the visit. The facility is licensed to serve six (6) residents over the age of 60, of which four (4) may be non-ambulatory and one (1) bedridden. LPA OBSERVATIONS: The facility is a single-story building located in a residential neighborhood with five (5) resident bedrooms, three (3) bathrooms, kitchen, dining room, living room, front yard, backyard, and detached garage. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. Kitchen sink water temperature was measured at 115.0 degrees F. Kitchen appliances were observed to be clean and in working order. Dining Room/Living room/: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed to have plenty of seating and lighting. LPA Ramirez observed private caregiver#1 feeding resident#2 (R2) breakfast at dining room table. LPA Ramirez observed Staff#3 (S3) providing care and supervision to residents at the dining room table. Linen Closet: Contained plenty linens, towels, hygiene products, and extra PPE supplies. Resident Rooms 1 - 5: LPA Ramirez observed all five (5) resident bedrooms to contain required furnishings, lighting, and linens. Bathrooms: Signs promoting hand washing were observed in all bathrooms. Water temperature in all three (3) resident bathrooms were within 105- 120 degrees F. Bathrooms were observed to be clean and well stocked. See 809-C Emergency Drills: Last documented drill was conducted on 9/30/23. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways and smoke detectors were observed to be operable. Staff Personnel Files: Staff files are maintained at facility. LPA Ramirez reviewed staff files for six (6) staff. LPA Ramirez observed Administrator’s certificate for Linda Morales with an expiration date of 01/03/2025. Staff#1 (S1) personnel record could not be located. Staff #3(S3) and private caregiver #1 did not have proof of fingerprint clearance nor personnel record to review. LPA Ramirez will issue civil penalties of $200 for violation of criminal clearance. Resident Files: Six (6) resident files were reviewed. Liability Insurance & Infection Control Plan: Facility has current liability insurance on file. LPA Ramirez observed updated infection control plan. Deficiencies are being cited and civil penalties. Exit interview was conducted with Administrator Morales and a copy of this report, LIC 809-D, and appeals rights was provided.