Routine inspection·April 9, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Jose Segura and explained the reason for the visit. Administrator (Admin) Rebekah Buboi arrived on premise approximately 2:30pm to assist with the inspection. The facility is a two story home licensed to operate for six non-ambulatory residents of which one may be bedridden and maintains a hospice for three. During today's visit, LPA observed four residents in care and one staff on duty. LPA toured the physical plant with Admin and observed the following: There are five resident bedrooms and two resident bathrooms on the first floor. The second second floor is occupied by the licensee's family member which residents do not have access to. Resident bedrooms had all required furnishings. Bathrooms were found to be in compliance, clean, and operational, however the hot water temperature in the resident bathrooms measured at 123.2 and 131.9 degrees Fahrenheit. All common areas were inspected including the attached two car garage which doubled as a laundry area. LPA observed at least 72 hour supply of emergency food and water. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available in the kitchen. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was serviced on August 15, 2024. The auditory devices and dual-functioning smoke/carbon monoxide detectors were tested and operational with repair, however one detector was missing in a vacant resident bedroom. Emergency evacuation drills are not conducted quarterly. There were no logs showing the drills were being conducted. The first aid kit contains all necessary elements. The Complaint Poster, 'See Something, Say Something,' (PUB 475) was not available. No discrepancies noted with staff record. In review of the resident records, the Physician's Report (LIC602) was not updated for Resident #2 (R2). The following items were addressed during the exit interview: to organize all files/records to prevent a delay in reviewing of the records during an inspection, to amend the Emergency Disaster Plan (LIC610E), to conduct quarterly emergency disaster drills and maintain a log, to install one dual-functioning smoke/carbon monoxide detector in a vacant resident's bedroom, to ensure the hot water is within the required range of 105-120 degrees Fahrenheit, and to obtain an updated medical assessment for R2 that contains all necessary information reflected on the LIC602, Physician's Report. Based on the observations made during today's visit, deficiencies are being cited. Advisory Notes (LIC9102s) are also being issued. An exit interview was conducted Administrator Rebekah Buboi and a copy of this report including the LIC809-Ds, LIC9102s, LIC811, and the appeal rights were provided at the end of the visit.