Routine inspection·October 28, 2022

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. Staff called the Administrator (AD) Joselolito Soliven via telephone who later arrived and was present for the visit. AD Soliven is waiting on his new Administrator Certificate to arrive. At 2:48 PM LPA Haley began the tour of the facility with staff. There were three residents present for the visit. The living room area was clean and well organized. Right next to the front door, there's a locked medication cabinet with two first aid kits, resident, and staff files. In the medication closet hygiene items was observed, along with additional N95 mask. Right next to the medication closet was a screening station with hand sanitizer, temperature thermometer, and several log books. All resident bedrooms were clean, well organized, and had all necessary requirements: night stand, chair, lamp and storage space. The resident bathroom was clean and organized. Hot water temperature was measured at 105.1 degrees Fahrenheit. The kitchen was clean and organized. All knives and sharp objects were locked under the sink. All burners on the stove were operational. There was a knob missing on the stove, but the burner did work. A two day supply of perishable food items and seven day supply of nonperishable food items was observed. A fully charged fire extinguisher was mounted on the wall. A washer and dryer was observed in a rear section of the kitchen. Above the washing machine was a locked cabinet with laundry detergent and additional supply of non-perishable food items. The garage was clean and well organized. An extra refrigerator with a supply of perishable items was observed. there's a file cabinet with a supply baby wipes. In the garage LPA observed several boxes of adult diapers and a emergency supply of water. Continued on LIC809C The backyard was clean and free of clutter and debris. both side exit gates were self closing and self latching. A shaded patio area, tables and chairs was observed. In the corner of the shaded patio area LPA observed a small storage cabinet with some gardening tools inside. While inspecting the backyard LPA noticed a cracked bedroom window and a door to the facility missing a door knob. AD Soliven was present and acknowledged the broken window and the missing door knob. AD Soliven acknowledged the broken window and said that was his bedroom. LPA Haley advised the importance of keeping the facility in good repair at all times. No bodies of water was observed. Smoke detectors tested operational. A deficiency will be cited as a result of todays visit. An exit interview conducted and a copy of the report LIC809D, and Appeal rights were provided to the Administrator Joselilto Soliven.