Routine inspection·October 7, 2024

Licensing Program Analyst (LPA) Alberto conducted the required annual inspection. LPA arrived unannounced and met with Caregiver Maedna Arbis who allowed the entry of the facility and explained the purpose of the visit. Shortly after the administrator Michelle Aguirre arrived and assisted with the visit. The facility is licensed for residents ages 60 and over, may retain a maximum of four (4) hospice residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: The Infection Control Plan has been added to the Operation Plan. The facility has a Dementia Waiver in place. A Hospice Waiver for 6 residents is approved. Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 3. Physical Plant and Environmental Safety: The facility is a single-story house and located in a residential neighborhood area. The facility includes Dining area, kitchen, sitting room, three residents bedrooms, two resident bathrooms, one guest bathroom, laundry room, live in staff room and a detached garage. Each resident bedroom has two beds, two drawers, required beddings and furniture and sufficient lighting and closet space. The two residents bathrooms are clean, sanitary and in a good working condition. Both bathrooms have the required grab bar and non-skid mat. The two bathrooms hot water temperature were tested between 127.9 and 129.9 degrees F. which is not within the Tittle 22 regulation. All the appliances in the kitchen and living room are working well. The sharp knives are stored in a locked kitchen drawer. (Continue on 809C) All the cleaning supplies and chemicals are stored and locked in a cabinet in the laundry room. The linen and towels are stored in the hallway cabinet. The extra personal hygiene products are stored in the laundry room cabinet. The carbon monoxide detectors were inspected, and they are working properly. The facility has patio with table and chairs for resident to utilize outdoor activity. The Passageway, walkway and patio are free of obstruction. 4. Staffing: The facility has sufficient staffing, and the night supervision staff did receive planned emergency training. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. All the direct care staff received Medication Management Training. The first aid training certificates for staff is current. 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, 1 resident does not have current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster and Residents personal rights are posted by the main entry. Visiting hours were posted at facility. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be very clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept very clean and free from rodents. 10. Incidental Medical and Dental: The medication is centrally stored and locked in the medication cabinet in the kitchen. Four (4) centrally stored resident medications were reviewed, which contained 30-day supply of medications. R4 did not have doctor’s order or label. Facility will provide transportation to resident for medical and dental appointment if needed. 11. Disaster Preparedness: The last fire drill was conducted on 0910/2024. Records of resident Appraisal and Needs services plans are part of Emergency training. The facility has an Emergency Disaster Plan (LIC610E) dated on 09/14/24 that needs to be update. The facility has two alternative temporary shelter location. 12. Resident with Special Health Needs: Two (3) residents are receiving home health services. One (3) receive hospice care. No resident is currently on postural support. Half and full bed rails for mobility assistance were observed in resident rooms with physician order. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. Deficiencies observed during today’s visit. Technical Advisory provided. An exit interview was held. A copy of this report, one technical advisory note, and appeal rights were provided.