Routine inspection·October 17, 2024

Licensing Program Analysts (LPAs) Abdoulaye Zerbo and Armando Perez conducted an unannounced visit to the facility for the purpose of conducting a required annual inspection . The LPAs were greeted by administrator Lorena Doguillen, notified her of the purpose for the visit and were allowed to enter the facility to conduct the inspection. Licensee Mody Trupti joined at a later time and she was informed of the purpose of the visit. Facility Overview: The facility is a single-story building with 4 residents bedrooms, 1 staff bedroom and 3 bathrooms. There is no gated pool and there are no firearms on the premises. Infection Control: LPAs observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in kitchen cabinet under the sink and inaccessible to residents. The smoke detector and carbon monoxide detector were tested and were operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with and expiration date of 4-11-25. LPAs observed the hot water temperature to meet requirements. The temperature was measured at various locations and averaged at 109.5°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two day supply of perishable foods. LPAs observed many items of the non-perishable food in the pantry to be expired. When the items were taken out, the facility did not meet the required seven day supply of non-perishable foods. Licensee informed LPA's a staff member was currently grocery shopping and will replace and restock the items needed to be in compliance. The violation will be addressed Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of April 27 th , 2025 and a CPR certification with expiration date of 10-25-25. Record Review and Resident/Staff Files: LPAs reviewed files for three staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four residents’ files were reviewed and contained all required documentation. LPAs observed Staff, resident files, first aid kit were locked in a cabinet in the hallway, emergency food and water were stored in the garage and the PPEs were stored by the front door. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked located in the hallway cabinet. Disaster Preparedness: LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 8-6-2024, which met department requirements. All facility exits were clear of obstructions except one(1) non-ambulatory room where a recliner was blocking the exit door. Staff instantly relocated the recliner to meet compliance. A technical violation will be addressed for documentation purposes One (1) deficiency was cited during the visit and a technical violation was issued. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Mody Trupti along with the appeal right.