Routine inspection·July 12, 2024

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Rosekie Cristobal. Caregiver Michael Abada arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory and one may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were stored in locked areas. LPA observed medication for one resident stored in a zip lock bag with no prescription label. No pool or body of water was present. Water temperature was measured at 109 degrees F. Per Michael, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit was complete. Resident records reviewed did not have needs and services plan in 4 of 4 residents. No medical assessments were present for two of four residents. One resident with a major neurocognitive disorder's most recent medical assessment was from 2021. Hospice resident full bed rail orders were present. Staff records reviewed contained required documentation. Multiple deficiencies were issued on today's date. An exit interview was conducted with Michael Abada, to whom a copy of this report, LIC809 D (x3) and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.