Routine inspection·April 24, 2025

Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by Administrator (AD) Ester Dela Cruz after explaining the purpose for the visit. LPA observed that Administrator Ester Dela Cruz submitted a renewal application to the Administrator Certification Bureau (ACB) on April 7, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, and has a hospice waiver for five. The facility is a single story home with four resident bedrooms, two of which can be shared, one staff bedroom, three shared resident bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA, accompanied by the AD, conducted a tour of the interior portion of the facility. On today's visit, LPA observed four residents in care, three of which are on hospice, and four staff present. LPA observed residents relaxing in their respective bedrooms and in common areas. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the dining room. LPA inspected the four resident bedrooms and they were observed to be free of hazards. Resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA tested the individual smoke detectors in each of the resident rooms which tested operational. LPA observed the staff bedroom to be kept locked and inaccessible to residents in care. LPA inspected the three resident bathrooms and they were observed to be clean. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 108.5 and 109.4 degrees Fahrenheit. CONTINUED ON 809-C LPA observed the kitchen has a two day perishable and a seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked storage container in the kitchen. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed fire extinguishers to be mounted on the wall in the kitchen and near the exterior shaded outdoor seating area. Fire extinguishers were observed to be charged and serviced as of April 29, 2024. LPA tested the individual carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on March 31, 2025. LPA observed the centrally stored medication to be stored in a locked storage cabinet in the kitchen. LPA observed the facility has a First Aid Kit stored in a closet by the living room and it had all the required components. LPA observed a fire place in the living room to not be in operation at time of visit. LPA observed the facility has an internet device for dedicated resident use stored in the dining room. LPA, accompanied by the AD, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gates on the west side and east side of the facility to be self latching and can be opened in an evacuation. LPA observed two laundry detergent containers left unattended by the unattached garage. LPA observed the door leading to the unattached garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply to be stored in the garage. LPA reviewed all four resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed all four residents' medication and medication records. LPA reviewed four staff files. LPA observed that the facility did not have a Health Screening report on file for the four staff. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached 809-D. An exit interview was conducted with Administrator Ester Dela Cruz. A copy of the report and Appeal Rights were provided.