Routine inspection·February 12, 2025

On 02/12/2025 at 11:45 AM, Licensing Program Analysts (LPAs) Melody Brown and Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs Brown and Serrano met with a Administrator Evelyn Cabales and was granted entry to the facility. At the time of the visit there were two (_2_) staff present, and three (_3_) residents present.LPAs Brown and Serrano explained the purpose of the visit to Administrator. The facility is a Five () bedroom, three (3) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of five (5) residents of which five (5) can be non-ambulatory. The facility has five (5) Hospice Waiver. The current census is three (3) residents. LPAs Brown and Serrano was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPAs Brown and Serrano observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 78 degrees Fahrenheit. LPAs Brown and Serrano inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA Brown observed sufficient lightning. Moreover, LPAs Brown and Serrano observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. LPA observed that the loft on the second floor was converted into a bedroom. Deficiency will be issued. Also, LPAs Brown and Serrano observed Resident #1 (R1), Resident #2 (R2), Resident #3 (R3 have half bed rails. Administrator Cabales reported to LPAs Brown and Serrano that R1, R2, R3 does not have written order from their physician indicating the need for half bed rail for mobility. Deficiency will be issued. ***Continuation in LIC809C *** Moreover, during the tour of the facility, LPAs Brown and Serrano observed sufficient furniture and lighting throughout the facility. LPA Serrano measured and observed the water temperature in the bathroom to be at 111.3 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. Furthermore, during the tour of the facility, LPAs Brown and Serrano observed the sharps and chemicals locked in kitchen cabinets, inaccessible to residents in care. There is a designated storage space for resident/staff files. The resident’s medications is locked in the medication drawer inaccessible to resident in care. Yards/Outside: One shaded patio, one (1) side gate with self-latching handle on the right side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstructions. Food Service : Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. LPA observed that the facility do not have the 72 hour emergency food and supplies ready to go in case of a disaster. Deficiency will be issued. Care & Supervision : The facility has an administrator present during the visit. LPAs Brown and Serrano observed sufficient number of staff to provide care and supervision to the residents in care. No dementia residents observed at the facility. Record Review : LPAs reviewed resident #1 (R1) resident#3 (R3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA observed that the admission agreement for R1 was not signed and dated by the licensee/designee and R3 pre-placement appraisal was not signed and dated by the representative. LPAs observed during medication audit that R3 that one (1) medication was not given for 2 days. Deficiency will be issued. ***Continuation in LIC809C *** LPAs reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPAs found that Staff #2 (S2) does not have an updated first aid certification and health screening. Deficiency will be issued. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and Appeal Rights were discussed and provided to Administrator Evelyn Cabales.