Routine inspection·May 19, 2025

On May 19, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Assistant Administrator (AD) Maria Tavarez was present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents, One (1) may be bedridden, with approved hospice waiver for four (4) residents. Currently, there is three (3) Hospice residents present during today’s visit. This is a single story home with detached garage facility. The facility has five(5) resident bedrooms (four private, one shared) and one (1) staff room with two bathrooms. At around 12:45 PM, LPA conducted a tour of the physical plant accompanied by Assistant Administrator Maria Tavarez, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 105.4 to 108.8 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning products and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA observed two fire extinguishers which was fully charged and mounted. CONTINUED ON 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed the facility has a supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on May 1, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 8/1/2024 – 8/1/2025. A review of five residents (R1-R5) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Robert Dale Kalagayan # 6067291740 - Expiration 08/07/2025. No deficiencies during this inspection visit. An exit interview was conducted with Assistant Administrator Maria Tavarez, and a copy of the report was provided.