Routine inspection·December 20, 2024

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Victoria Mejia, Caregiver and explained the purpose of today's visit. Administrators Nvard Gevorkian and Diana Castellanos arrived shortly after and assisted LPA with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor screening station at the entrance of the facility. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan and was reviewed. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff are adhering to infection control requirements. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed to serve 6 non-ambulatory residents ages 60 and over, of which (1) may be bedridden. Waiver granted for (2) hospice care. Current census is six (6) of which one (1) is under hospice care. Home consists of six (6)resident bedrooms, 2 bathrooms, living room, dining room, kitchen, backyard, and a detached garage being used as a staff rest area. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors are operational. The facility has (2) fire extinguishers in the facility which were last serviced on 10/08/2024. There are cameras in the common areas. Cleaning supplies and toxic substances are inaccessible to clients. At 10:20am, hot water temperature readings measured 116.9 deg F in bathroom #1 and 109.2 deg F in bathroom #2 which are within the required 105-120 degrees Fahrenheit. Operational Requirements : Infection Control and Dementia plans have been added to the Plan of Operation. A fire clearance is in place. Liability Insurance policy is valid and will expire on 05/17/2025. The last fire Drill was conducted on 09/17/20243. Care and supervision to meet the residents needs was observed. Special equipment and supplies to meet the persons with special needs were observed. ***CONTINUED ON LIC 809-C** Staffing: A total of nine (9) caregivers including the (2) Administrators provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: Administrator certificate is valid and expires on 12/23/2024, renewal has been submitted in September 2024. Four (4) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings and First Aid/CPR training. Resident Records-Incident Reports: Six (6) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records, Restricted Health Care Plans and Hospice Notes/Records were reviewed. Resident Rights-Information: Resident personal rights are posted. Physician orders for use of full bed rails were reviewed in (1) resident file who is under hospice care. Four (4) other residents use 1/2 bed rail with physician orders, but one (1) resident did not have the order on file. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. Information regarding Dementia is part of the training for direct care staff and is included in the Plan of Operation. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator. 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. Medications reviewed for all (6) residents. Incident Medical and Dental: All residents have Restricted Health Care Plan and Needs and Services Plan on file. Currently, (4) residents receive Home Health care in the facility. Residents medication are centrally stored in a locked cabinet next to the kitchen area. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. The facility conducts emergency drill on a quarterly basis. Residents with SHN: One (1) resident receive hospice care. Appraisals were observed in resident files. No residents have prohibited health conditions. Deficiencies cited, exit interview conducted and a copy of the report along with the appeal rights were provided to the Administrator, Diana Castellanos.