Routine inspection·June 8, 2023

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced site visit for the Required - 1 year continuation inspection using the full Care Compliance and Regulatory Enforcement (CARE) Tools. Upon arriving at the facility, LPA met with Administrator / Jennifer Leon who assisted with the visit. LPA explained the purpose of this visit. The facility is licensed to serve for a capacity of six (6) Residents ages 60 and over. The facility has an approved fire clearance for five non-ambulatory residents and one bedridden resident, designated to room #4. Hospice care waiver approved for six (6) residents. Currently, there are six (6) residents in placement. There is one (1) bedridden resident and four (4) residents receiving hospice services. The facility has an approved Dementia Care plan as part of its plan of operation and accepts/cares for residents with dementia. During the initial Required - 1 Year inspection conducted on 6/2/23, LPA Katrdzhyan observed and reviewed the following (CARE) tool domains: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Food Service and Health Related Services/Incidental Medical & Dental. As part of today's inspection, LPA observed and reviewed the remaining (CARE) tool domains: Personnel Records/Staff Training, Resident Records/Incident Reports, Resident Rights/Information, Planned Activities, Disaster Preparedness and Residents with Special Health Needs. Personnel Records/Staff Training: Administrator's Certificate is current and expires on 8/8/2024. Staff have criminal background clearance and training. A random selection of staff files were reviewed. First Aid/CPR training, Personnel Record, Health Screening, Criminal Record Statement, Employee Rights and Staff Training. Resident Records/Incident Reports: A random selection of resident files were reviewed. Admission Agreement, Physician's Report, Consent Forms, ID & Emergency Information, Appraisal & Needs Service Plan, Immunization/TB clearance, Centrally Stored Medication Destruction Record, Safeguards for Property Valuables and Personal Rights. The Incident report binder was reviewed. Resident Rights/Information: RCFE complaint poster and Personal rights were observed posted. Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints was posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted in a centralized location. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. Records of resident Appraisal and Needs services plans are part of Emergency training. Residents with Special Health Needs: One (1) resident is receiving home health services. There is one (1) bedridden resident and four (4) residents receiving hospice services. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. No deficiencies were observed during this visit. An exit interview was conducted and a copy of this report was provided to the Administrator.