Routine inspection·May 9, 2025

On May 8, 2025 at 1:45 PM, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator (AD) Vijay Kanase was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Vijay Kanase submitted a Administrator renewal application to the Administrator Certification Bureau (ACB) on April 14, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one can be bedridden, and has a hospice waiver for four. The facility is a single story home with four resident bedrooms, two of which are shared, three resident bathrooms, a living rooms, a dining room, a kitchen, a laundry room, and an attached 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 and three 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 entryway of the facility. LPA inspected the four resident bedrooms and they were observed to be free of hazards. LPA observed residents bedrooms to have 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 inspected the three resident bathrooms and observed them to be free of hazards. Resident bathrooms were equipped with grab bars and non-skid floors. Faucets and toilets were operational. Hot water temperature measured between 123.6 to 123.8 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. The four burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed a Fire Extinguishers to be mounted by the kitchen and it was observed to be charged and serviced as of January 21, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on May 2, 2025. LPA observed the centrally stored medication to be kept in a locked cabinet in the kitchen. LPA observed the facility has a First Aid Kit stored in a kitchen cabinet and it has all the required components. LPA observed the door leading to the laundry room to be kept locked and inaccessible to residents in care. LPA observed chemicals and toxins to be stored in the locked laundry room. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed additional linens to be stored in the garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. 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. There are no bodies of water on the premises. LPA reviewed all four resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed residents' medication and medication records. LPA reviewed five staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, one deficiency is being cited on the attached 809-D. An exit interview was conducted with Administrator Vijay Kanase. A copy of the report and Appeal Rights were provided.