Routine inspection·August 14, 2024

On 8/14/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Administrator, Carmen Achim who was informed of the purpose of LPA's visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents. The facility also has an approved hospice waiver for three (3) and LPA was informed three (3) residents are currently receiving hospice services at the facility. During today's visit, LPA observed Staff 1 (S1), Staff 2 (S2), and five (5) residents present. LPA toured the facility with Administrator Achim and observed the facility is made up of a one-story home with six (6) resident bedrooms, six (6) resident bathrooms, a staff room, kitchen, dining room, living room and attached garage. During the tour, Administrator Achim tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed a charged fire extinguisher mounted in the hallway leading to the facility's backyard. Indoor and outdoor passageways were free of obstruction. The facility has outdoor shaded seating for the residents in care. There were no bodies of water observed on the premises. Medications are secured in a locked cabinet near the visitor's restroom. Resident bedrooms had the required furniture and lighting. Bathrooms had grab bars near the toilet and in the showers. LPA observed a hallway closet filled with clean linens and towels. The facility had a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Resident files reviewed had signed admission agreements and physician reports. Long Term Care Ombudsman and complaint information are posted near the front entrance. LPA attempted to review the personnel records for the S1 and S2 present. Administrator Achim reported the facility does not have personnel records for S1 and S2. Administrator Achim added S1 and S2 had their personnel records in their car and recently had a car accident and no longer have their records. Additionally, interviews and a record review, revealed S1 present has not submitted to a criminal record clearance or obtained an exemption to work in the facility. Administrator Achim added they did not double check to verify S1 possessed a criminal record clearance or exemption prior to working in the facility. S1 was interviewed and reported they have been working in the facility for one (1) week. During today's visit, LPA issued a deficiency for the lack of personnel records and assessed a civil penalty for S1's lack of criminal record clearance or exemption. An exit interview was conducted where this report was reviewed and provided to Administrator Achim along with a LIC 809-D, LIC421BG, Confidential Names List (LIC 811), and Appeal Rights.