Routine inspection·May 23, 2025

On May 23, 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) Marebith Nery was notified via telephone and later arrived to assist with the inspection. LPA observed that Marebith Nery has a valid Administrator certificate which expires on July 22, 2025. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one can be bedridden, and has a hospice waiver for six. The facility is a two story home with five resident bedrooms, four resident bathrooms, a living room, a dining room, a kitchen, a staff office, 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 four residents in care and three staff present. LPA observed residents relaxing in their respective bedrooms and eating breakfast in the dining room. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the resident hallway. LPA inspected the five 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 cabinet. LPA inspected the four resident bathrooms and observed them to be free of hazards. Resident bathrooms were equipped with grab bars and non-skid floors. Faucets and toilets were operational. Hot water temperature measured between 112.4 to 117.3 degrees Fahrenheit. LPA observed the second story of the home to have a staff office. LPA observed the staff office to be off limits to residents in care. CONTINUED ON 809-C LPA observed the kitchen has a two day perishable and a seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. The five burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed fire extinguishers to be mounted in the kitchen, in the resident hallway, in the garage, and by the entryway of the facility. LPA observed fire extinguishers to be charged and up to date on service. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the centrally stored medication to be kept in a locked closet by the entryway of the facility. LPA observed the facility has a First Aid Kit stored in the locked closet and it has 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 the facility has a three day emergency food and water supply 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 gates on the north side and south 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 four resident files. LPA observed the facility did not have a Medical Assessment on file for Resident #2 (R2) and Resident #4 (R4). LPA observed the facility did not have a Pre-admission appraisal on file any of the four residents. LPA reviewed residents' medication and medication records. LPA observed the facility did not have a valid prescription for seven supplements/vitamins for Resident #3 (R3). LPA reviewed six staff files. LPA observed that zero out of three staff that were present at time of visit, did not have a valid CPR card on file. 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 Marebith Nery. A copy of the report and Appeal Rights were provided.