Routine inspection·May 14, 2025

On May 14, 2025, 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) Bindi Shah was notified via telephone and later arrived to assist with the inspection. LPA observed that Bindi Shah has a valid administrator certificate which expires on June 27, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a two story home with five resident bedrooms, one of which is shared, three resident bathrooms, a living rooms, a dining room, a kitchen, 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 six residents in care, two of which are on hospice, and two care giving staff present. LPA observed residents relaxing in their respective bedrooms and in the living room. LPA inspected the five 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 observed additional linens to be stored in a hallway closet. LPA inspected the three resident bathrooms. Resident bathrooms were clean. Resident bathrooms were equipped with grab bars and non-skid floors. Faucets and toilets were operational. Hot water temperature measured between 117.5 and 119.7 degrees Fahrenheit. The second story of the home if for staff use only and is off limits to residents in care. 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. CONTINUED ON 809-C LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a separate locked kitchen cabinet. LPA observed a fire extinguisher to be mounted in the kitchen and it was observed to be charged and serviced as of May 12, 2025. LPA tested the wired smoke detectors which tested operational. LPA tested the individual carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on April, 2025. LPA observed the centrally stored medication to be kept in a locked hallway closet. LPA observed the facility has a First Aid Kit stored in the locked closet and it had all the required components. LPA observed the facility has a three day emergency food and water supply stored in a hallway closet. LPA observed fireplaces in the living room and by the resident hallway and they were observed to be adequately fenced and not in operation at time of visit. 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 and laundry. 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 is a pool located in the backyard which was observed to be adequately fenced and kept locked for resident safety. LPA reviewed all six resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed residents' medication and medication records. LPA reviewed three 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 Bindi Shah. A copy of the report and Appeal rights were provided.