Pre-licensing visit·June 28, 2022

Licensing Program Analysts (LPAs) Edward Tapia, Patricia Velazquez and Jessica Cho conducted an announced Pre-Licensing visit with Component III Orientation at The Country Gardens Terrace, Inc. LPAs Tapia, Velazquez and Cho conducted the visit with Administrator Jean Catacutan and Licensee Jacqueline Dizon . An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 02/28/2022 for a capacity of 6 non-ambulatory residents. LPAs Tapia, Velazquez and Cho along with Administrator Catacutan and Licensee Dizon observed the following: Structure: Facility is a one story building with 6 resident bedrooms and 1 staff room, 6 bathrooms, dining room, living room which doubles as an activity room, kitchen and 2 car garage. The facility has a dark brown stucco exterior with a latched fence and optional seating in the front yard. There is a courtyard in the backyard with a fountain outside with shading and seating for residents. Bedrooms Residents : All bedrooms accommodate non-ambulatory residents. Emergency lighting was present in the facility. The resident bedrooms accommodate the residents' required furnishings. Bathrooms: All bathrooms have a working toilet and wash basin. Four of the bathrooms have a walk-in shower. Two bathrooms have a shower/tub combination. Grab bars were secure and a non-skid mat was in place. Linens and Hygiene Supplies: Adequate supply of linens and hygiene supplies were located in a linen cabinet in a hallway as well as the resident rooms. Appliances: Refrigerator, freezer, dishwasher, washer and dryer, microwave and electric stove top. Emergency Phone Numbers, Exit Plan: Posted in the dining area of the facility and readily available for review. Postings: The Complaint poster was posted in the entry area of the facility. Coronavirus (COVID-19) postings were observed posted throughout the facility. Food Service and Menu: There was an adequate supply of 7 day non-perishable and 2 day perishables present in the facility. The sample menu was available for review. The emergency food supply was inadequate for 6 residents. Smoke and Carbon Monoxide Detectors: Smoke detector and Carbon Monoxide alert systems were interconnected tested and found to be operational. Fire Extinguisher: Fully charged and were mounted on the walls throughout the facility. Fire Clearance: Approved on 04/18/2022 for 6 non-ambulatory residents. Toxins and Sharps: The cleaning supplies and knifes were locked and stored in a cabinet underneath the kitchen sink. Water Temperature: Tested and recorded in 6 resident bathrooms and ranged between 103.1 - 109.7 degrees Fahrenheit. Medications, First Aid Kit & Manual: The facility has 2 First Aid kits which were checked and found to be in order. One First Aid kit is located in the medication room and the other is located in the office. The facility was missing a First Aid manual. Medication is stored in a locked cabinet located in the medication room. Resident and Staff Files: Resident and staff records are stored in the office. Reading Material, Games, Equipment, & Materials: The facility had materials, games, and equipment present in the facility that commensurate with their plan of operation. Component III: Conducted at the Pre-Licensing visit, information was provided about how to operate the facility within compliance. The following items need to be addressed prior to licensure: · Obtain chairs for the resident rooms · Obtain a First Aid manual · Obtain lamps for the resident rooms · Facility does not appear ready for licensure. Any items noted during today’s visit are to be corrected by June 14, 2022. LPA Velazquez will conduct a subsequent Pre-Licensing visit on June 14, 2022 to review the items listed above. An exit interview was conducted with Administrator Aurelia Olais and Licensee Diluvan Hassan a copy of this report was provided at the time of this visit. Medications, First Aid Kit & Manual: The facility has a First Aid kit which was checked and found to be in order. The First Aid kit is located in the medication section in the dining room. Medication is stored in a locked cabinet located in the medication area. Resident and Staff Files: Resident and staff records are stored and locked in the dining area. Reading Material, Games, Equipment, & Materials: The facility had materials, games, and equipment present in the facility that commensurate with their plan of operation. Component III: Conducted at the Pre-Licensing visit, information was provided about how to operate the facility within compliance. The following items need to be addressed prior to licensure: Repair or replace light and light switch in the kitchen Repair or replace latches for exit gates Add a low profile threshold ramp Obtain a current first aid manual Emergency food and water supply Obtain mattress pads for room 6 Obtain no smoking oxygen in use signs Repair or replace left rear burner for stove-top Remove excessive grease stains in overn and over racks Facility does not appear ready for licensure. Any items noted during today’s visit are to be corrected by July 12, 2022. LPA Velazquez will conduct a subsequent Pre-Licensing visit on July 12, 2022 to review the items listed above. An exit interview was conducted with Administrator Jean Catacutan and Licensee Jacqueline Dizon copy of this report was provided at the time of this visit.