Routine inspection·January 17, 2024

At approximately 10:25 AM Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced to conduct an annual required inspection and met with Assistant Administrator, Shannon Gayski. LPA and Assistant Administrator discussed the purpose of the visit. LPA initiated a tour of the facility around 11:00 AM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in sinks accessible to residents measured at 114, 109 and 116 degrees F which are within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cleaning supplies were stored in a locked cabinet outside. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water supplies are stored in an outdoor storage shed. Personal Protective Equipment is stored in back storage room. Fire extinguishers were last serviced December 2023. Facility has combination Smoke/ Carbon Monoxide detectors that were tested and operational during visit. Most recent fire/disaster drill was conducted 12/01/2023. 5 staff files and 5 resident files were reviewed. Staff have required First Aid and CPR certificates. Training records were reviewed. Administrator Certificate for Administrator, Rolando Macaraig (6012447740), is up to date and expires 03/24/2024. Medications and medication records were reviewed. Continued on LIC809 Continued from LIC 809 Administrator to submit updates of the following documents by 02/17/2024: LIC 500 Personnel Summary Copy of Liability Insurance LIC 9020 Register of Residents Emergency Disaster Plan (If changes) Infection Control Plan (If changes) No deficiencies cited during inspection. Exit interview conducted. Copy of report discussed and provided to Assistant Administrator. Signature on form confirms receipt of documents.