Routine inspection·August 14, 2023

LPA Alberto Lopez made unannounced visit to conduct the annual inspection. LPA met with Conchita Pasion and Bob Allado Live in caregivers and explained the purpose of visit. The facility is licensed to serve 6 (six) non-ambulatory residents ages 60 and over of which 1 (one) may be bedridden and facility is approved to retain 2 residents on hospice. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and 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 are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies but did not have an infection Control Plan at facility. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are currently 2 non-ambulatory 1 ambulatory and 3 bedridden residents residing at the facility. The facility has the sufficient amount of liability insurance covering injury to residents and guest. Physical Plant & Environment Safety: There are no pool or bodies of water at the premises. There are 6 resident rooms bedrooms and two staff bedroom, 4 bathrooms, living room, dining room, and kitchen, 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 bathrooms were measured between 108.1 - 113.7 degrees F which is within required range of 105-120 degrees F. Continued on (809C) Staffing : There appears to be sufficient staffing at the facility. The administrator's (Rafeal Diaz) certificate has expired. Staff employed are all over the age of 18. Personnel Records-Training : Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Identification & Emergency Information, Original Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. All residents files need updated Admission Agreements and Physicians reports. Resident Rights-Information: The Complaint poster and Residents personal rights are posted by the main entry. Visiting hours are 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. Seven-day non-perishable items are not sufficient. 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 all medication is administered according to doctor’s orders. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The staff received training on appropriately caring for residents with dementia, those on hospice, and receiving oxygen. No Smoking - Oxygen signs are not posted on the doors of residents using oxygen. Deficiencies as well as technique advisories were given Exit interview conducted and copy of report and appeal rights provided.