Routine inspection·April 28, 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) Cheryl Sansano was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Cheryl Sansano has a valid Administrator certificate on June 19, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for six. The facility is a two story home with four resident bedrooms, two of which are shared, two shared resident bathrooms, two staff bedrooms, one staff bathroom, a living room, 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 five residents in care, one of which is on hospice, and three staff present. LPA observed residents relaxing in their respective bedrooms and in common areas. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the four 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 two shared 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 125.7 and 128.4 degrees Fahrenheit. The second story of the facility has two staff bedrooms and one staff bathroom. LPA observed the second floor of the facility to be for staff use only and off limits to residents in care. LPA observed staff bedrooms to be kept locked and inaccessible to residents in care. CONTINUED ON 809-C LPA observed the facility has a two day perishable and a seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the four burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed a fire extinguisher to be mounted on the wall by the kitchen and it was observed to be charged and up to date on service. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on January 15, 2025. LPA observed the centrally stored medication to be kept in a locked cabinet by the kitchen. LPA observed the facility has a First Aid Kit stored in the locked cabinet and it had all the required components. 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 observed chemicals and toxins to be stored in a locked cabinet in the garage. LPA observed the facility has a three day emergency food and water supply to be stored in the garage. 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 gate on the north side of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all five resident files. LPA observed the facility did not have a Pre-Admission Appraisal on file for Resident #1, Resident #3, and Resident #4. LPA observed the facility did not have a Reappraisal on file for Resident #1, Resident #2, Resident #3, and Resident #4. LPA observed the Reappraisal on file for Resident #5 to be outdated. LPA reviewed residents' medication and medication records. LPA reviewed four staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached 809-Ds. An exit interview was conducted with Administrator Cheryl Sansano. A copy of the report and Appeal Rights were provided.