Routine inspection·November 28, 2023

Licensing Program Analysts (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Claudia Ruiz and Crystene Char and discussed the purpose of today’s visit. This facility is approved for (81) ambulatory and (119) non-ambulatory residents (of which 10 may be bedridden). This facility has an approved hospice waiver for (15) residents. The following bedrooms are approved for bedridden residents: #206,207,208,209,210,106,107,108,109 and 110. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an Infection Control Plan in place. Operational Requirements: This facility is approved for (81) ambulatory and (119) non-ambulatory residents (of which 10 may be bedridden). This facility has an approved hospice waiver for (15) residents. The following bedrooms are approved for bedridden residents: #206,207,208,209,210,106,107,108,109 and 110. Staffing : Facility is adhering to staffing requirements. Personnel Records-Training : Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator/S-1 through Staff #6 (S-6). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained on Abuse Reporting and Resident Rights. Refer to LIC 809C for the continuation of this report. Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #10 (R-10). Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Appraisal/Needs and Services Plan, Resident Rights were observed. Resident Rights-Information: Resident rights are posted and included in Resident files. Planned Activities: Facility has an Activities Director and Activities Assistant. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. The following domains remain pending: Physical Plant & Environment Safety Food Service Health Related Services/Incidental Medical Services Exit interview conducted, copy of appeal rights and a copy of this report was provided to Crystene Char.