Routine inspection·January 31, 2025

On January 31, 2024, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrator (Admin) John Ortiz arrived to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents, (1) Bedridden with approved hospice waiver for six (6) residents. Currently, there are three (3) Hospice residents present during today’s visit. Facility is a two story home with an attached locked two-car garage used for storage. The facility has six bedrooms, (two shared resident rooms, two private rooms and two upstairs rooms for homeowner) and three bathrooms. Upstairs are living corridors for homeowner and residents do not have access to upstairs rooms. At around 1:00PM, LPA conducted a tour of the physical plant accompanied by caregiver, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens were available during the visit. Bathrooms were operational with water temperature measured at 115.8 degrees F. A comfortable temperature of 76 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA observed two fire extinguishers which were charged and mounted. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. CONTINUED ON LIC 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on January 6, 2025. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 2/4/2024 – 2/4/2025. A review of four residents (R1-R4) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Mae Ortiz # 7027316740 - Expiration 1/6/2026 No deficiencies during this inspection visit. An exit interview was conducted with Administrator Ortiz, and a copy of the report was provided.