Routine inspection·December 6, 2022

icensing Program Analyst(s) Mary Flores conducted an unannounced annual visit at the facility with focus on the infection control domain, food and medication review. LPA Flores met with Gaudeliza Evangelista caregiver and explained the reason for the visit. Ralph Estanislao administrator was notified over the phone. The facility is licensed to serve 5 non-ambulatory and 1 bedridden residents over the age of 60. The facility has 5 bedrooms, 3 bathrooms, a living room, a dining room, an activity room, a kitchen and an attached garage. The outdoor facility has a front yard, and back patio. LPA Flores conducted a tour of the facility with Lisa Evangelista caregiver and observed the following: Living room has a covered fire place, residents were observed sitting in TV area maintaining social distancing. Kitchen was observed, drawer for sharps is locked. LPA observed prepared medication cups for residents under computer desk. Medication cabinet was located to the right above the stove and locked. LPA Flores reviewed food supplies and facility has at least 2 days of perishables, and 7 days of non-perishable food supplies. Garage access door was unlocked, bleach and other cleaning supplies were observed upon entry the garage around the washer and dryer area. LPA observed half open curtains and tall furniture cabinet as divider in the left corner of the garage were three (2) mattresses and a sheet maid sofa with pillows were laid and personal belongins were observed. LPA observed All bedrooms have the required furniture, lighting, and bedding in each bedroom. Bedroom #1(BR1) has a half bed rail on bed for resident #1(R1), bedroom #2(BR2) has a full length rail for resident #2(R2), bedroom #4(BR4) has a half bed rail for resident #4(R4), and bedroom #5(BR5) has a side rail on the left side of the bed for resident #6(R6). Bathrooms were observed and three (3) bathrooms are in working condition. LPA tested water temperature in bathroom #19(B1) at 116.6 degrees F, bathroom #2(B2) at 112.8 degrees F, bathroom #3(B3) at 112.6 degrees F, which is within the required 105 - 120 degrees F. LPA Flores reviewed medication and files for resident #3(R3), #4(R4), and #6(R6). LPA requested physician's order for bed rails for resident #2(R2), R4, and R6 and administrator stated there is no physician's request on file. (CONTINUED ON LIC 809C) Smoke/Carbon monoxide detectors were tested and in working condition. No large bodies of water observed. Patio has a shaded sitting area available. LPA reviewed 3 staff file, staff #2(S2) and #3(S3) do not have a TB test clearance on file. Administrator certificate was observed for Ralph Estanislao #6053102740 exp: 3/17/2023. Deficiencies were noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Gaudeliza Evangelista Caregiver and a copy of this report, LIC 809D, and appeal rights were provided.