Routine inspection·November 4, 2024

Licensing Program Analysts (LPAs) Abdoulaye Zerbo, Andrei Castillo, and Ferrer Sabarias conducted an unannounced visit for a required annual inspection . The LPAs were greeted by the caregiver Titus Irungu, notified him of the purpose for the visit and were allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 4 residents bedrooms, 1 staff bedroom, 3 bathrooms and a garage. 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. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in a kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with an expiration date of 06/10/2025. LPAs observed the hot water temperature to meet requirements at 115.5°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 and a seven-day supply of non-perishable foods. 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 May 22 nd , 2026 and a CPR certification with the expiration date of 10-5-25 Record Review and Resident/Staff Files: LPAs reviewed files for four(4) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four (4) residents' files were reviewed and contained all required documentation. LPAs observed Staff and resident files, to be stored in a locked cabinet in the staff room. The first aid kit was stored in a cabinet in the pantry next to the living room. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the kitchen area. LPAs reviewed medications for four residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 09-01-2024, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Verona Gitau