Routine inspection·October 29, 2024

Licensing Program Analysts (LPAs) Cynthia Chan and Luis DeLeon conducted the unannounced annual inspection on 10/29/24. LPAs met with Staff, Genia Polistico, and explained the purpose of the visit. The assistant administrator, Elizah Arganosa, arrived shortly after to assist with the visit. The facility is licensed to serve 6 non-ambulatory residents, ages 60 and over. One may be bedridden and is approved for bedroom #3. There is a hospice waiver approved for 6. The facility is a single story home with 5 resident bedrooms, 1 staff room, 2 bathrooms, open living room, dining room, and kitchen, laundry room, and attached garage. Garage has an additional storage room. There is no swimming pool on the premises. The bathrooms have non-skid mats in the shower area and grab bars. Facility has smoke and carbon monoxide combo detectors that are operable and interconnected. Knives, cleaning solutions, and disinfectants are locked, making them inaccessible to residents. The facility has auditory devices on the exit doors. There is a sufficient food supply of 2 day perishable and at least a week of non-perishable food maintained at the facility. The hot water temperature was measured at 110.6 degree F which is within the required range. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is maintained. Staff and Residents files are stored and maintained at the facility. LPAs reviewed 5 resident and 4 staff files to ensure all required forms are in their files. One of the resident files did not have the TB test results upon admission. Medications are centrally stored and locked. LPA reviewed medications and there are no discrepancies. The facility accepts and retains residents with dementia and/or hospice. The facility has a "no smoking oxygen in use" sign posted at the facility and in front of the resident's room. Emergency Disaster Plan is easily accessible and disaster drills are conducted monthly. A deficiency is issued on the LIC809D. An exit interview was held and a copy of this report was given to the administrator.