Routine inspection·January 16, 2025

Licensing Program Analyst (LPA) Elizabeth Irra conducted an annual inspection visit. LPA met with Lourdes Bisnar and discussed the purpose of today’s visit. This facility consists of (4) resident bedrooms, (2) bathrooms (one in bedroom #1), a living room, dining room, kitchen and attached garage. This facility is approved for (5) non-ambulatory and (1) bedridden resident (bedroom #4). This facility is also approved for (6) hospice residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools observed the following: Infection Control: Facility has an Infection Control Policy in place and was observed to be posted. Operational Requirements: Facility is adhering to the operational requirements. Physical Plant & Environment Safety: LPA toured facility grounds. Fire smoke alarms and carbon monoxide detectors (near the dining area) observed. The fire extinguisher is located in the kitchen and was last serviced on 08/14/24. Last drill was conducted on 12/08/24. Bathrooms have non-skid surfaces and grab bars. Staffing : Facility is adhering to staffing requirements. Personnel Records-Training : Staff files are maintained at the facility. LPA reviewed staff files for S-1 through Staff #5 (S-5). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. **Refer to LIC 809C for the continuation of this report.** Resident Rights-Information: Resident rights are posted and are included in Resident files. Planned Activities: Activity schedule is posted near the dinning area. This facility also provides internet access to the residents. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. Posted menu observed. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining areas have adequate seating. Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #6 (R-6). Resident files are maintained at the facility. Resident files have the required documents. 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/Assessment Summary, Resident Rights were observed. Disaster Preparedness: The facility has a Disaster Preparedness plan in place and was observed to be posted. Health Related Services/Incidental Medical Services: The medications are stored and locked inside the hallway closet. Medications are administered as prescribed. Exit interview conducted, copy of appeal rights and a copy of this report was provided to Lourdes Bisnar.