Post-licensing visit·December 13, 2022

Licensing Program Analysts (LPAs) Elizabeth Irra and Glenn Trueman conducted a post licensing visit. LPAs met with Claudia Sanchez (Assistant Administrator) and Lupe Harvey (Facility Administrator) and explained the purpose of today's visit. During this visit, LPAs conducted a facility tour and reviewed files for Staff #1 (S-1) through Staff #6 (S-6). LPAs also reviewed Resident files for Resident #1 (R-1) through Resident #6 (R-6). The main building consists of two floors, there is a detached apartment in the back with 2 rooms located on the first floor and 3 rooms located on the second floor along with two detached cottages. The first floor in the main building consists of living room/television room, reception/office area, kitchen, dining room, conference room, laundry room and resident rooms. The second floor of the main building consists of resident rooms. The facility is approved for (48) ambulatory, (32) non-ambulatory of which (7) may be bedridden (rooms assigned for bedridden are B-1, A-2, A-4, A-5, A-8, A-9 and A-12). This facility has an approved hospice waiver for (15). There is (1) bedridden resident and there are (7) under hospice care. Resident bedrooms were equipped with a bed, chair, night stand, adequate lighting and ample closet/storage space for each resident. Appropriate linens and towels were observed. Bathrooms are clean and operational with non-skid mats. Appropriate food supply of two days of perishables and seven (7) days of non-perishables. Refer to LIC 809C for the continuation of this report. Resident and staff records are centrally stored and locked in the Executive Director's office. Each resident room is equipped with a smoke detector. Carbon monoxide detectors were observed. Fire extinguishers were fully charged and last serviced on 06/02/2022. Functioning telephone on the premises. Hot water temperature was tested throughout the facility. Water temperatures: room #1 measured at 119.8*, room #4 measured at 119.4*, room #6 measured at 112.2*, room #7 measured at 107.9*, room #11 measured at 113.1*, room #30 measured at 113.5*, room #32 measured at 105.2*, room #27 measured at 114.6* Toxins such as cleaning solutions and detergent soap and sharps are also locked in the storage room. Emergency Disaster Plan, Personal Rights and Facility Sketch were observed posted. Exit interview, appeal rights and a copy of this report was provided to Lupe Harvey-Facility Administrator.