Routine inspection·July 11, 2023

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced annual inspection at the facility. Upon arrival, LPA met with Olga Soto and explained the purpose of the visit. The facility is licensed to serve 6 residents 60 years and older. Five (5) can be non-ambulatory and One (1) Bedridden, facility has hospice waiver for two (2). LPA use the CARE tool for this visit. LPA observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents and medications. Disposals of trash are done immediately after changing a resident. Staff were still cleaning and disinfecting throughout the day. Sufficient PPE supplies and. Facility does not have an Infection Control Plan posted by the entrance. Physical Plant & Environment Safety: The 1-story facility is in good repair. Fire and carbon monoxide detectors are in every room. One smoke detector the hallway is not working. The 1-story facility consist of the following: 4 rooms, attached garage, 1 kitchen, 2 bathrooms, Facility has one screen in disrepair. Operational Requirements: The facility did not have plan on file to accept or retain residents with dementia on file. The facility does not have current liability insurance covering injury to residents and guest on file. Staff employed are all over the age of 18. Staffing : There appears to be sufficient staffing at the facility. The administrator’ Rafael Diaz did not have certificate on file and the ones posted had other names and are expired. . Personnel Records-Training : Staff files are not main tained at the facility. All staff have current CPR/first aid training and but no evidence of on-going training (Continued on 809C) Resident Rights-Information: The facility has internet access and facility has device for residents to use. No personal rights are posted at facility. Resident Records-Incident Reports: Resident files are maintained at the facility and do have the following documents in their files - Admission Agreements, Face sheet and other required documentation. All clients have overdue Physician’s report and needs and services plan. Food Service: Facility has supply of 2 day perishable food and 7 days of non-perishable food at facility. Health-Related Services: . Labels and PRN letters are missing from resident files. Incidental Medical Services: LPA reviewed 6 client medication files. Medications are administered according to doctor’s orders. Disaster Preparedness: The facility does have up to date Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Emergency Intervention: Facility has plan for emergency intervention. Civil penalties issued for repeat violation within 12 months. Deficiencies sited (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 House Manger Olga Soto