Routine inspection·March 7, 2024

On 03/07/2024 at 12:05 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met Licensee/Administrator Ofelia House and was granted entry to the facility. At the time of the visit there was one (1) staff present, and three (3) residents present. LPA Brown explained the purpose of the visit to Licensee/Administrator House. The facility is a six (6) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry room and detached garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which (6) can be non-ambulatory residents and one (1) may be bedridden resident. The facility has three (3) Hospice Waiver. The current census is three (3) residents. LPA Brown was accompanied by Licensee/Administrator House (S1) 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). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident shared bathroom. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 108 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarm. Posters such as personal rights, the CCLD complaint poster, Ombudsman poster and the disaster plan were posted in a common area. ***Continuation in LIC809C *** There is a steel cabinet with the resident’s medications locked in the activity area/office area. First Aid kit and first Aid book were observed at the facility. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility. However, LPA Brown observed no staff scheduled to work at night (NOC) shift and the facility have two (2) dementia residents. Deficiency will be issued. LPA Brown explained to Licensee/Administrator House that the facility must have at least one(1) night staff person awake, and on duty due to the facility having dementia residents. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and resident appraisals. LPA Brown observed Resident #1 (R1) Admission Agreement without Responsible Party Signature. Deficiency will be issued. Also, LPA Brown observed R1 without updated Physician Report as required for dementia resident. Deficiency will be issued. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with Tuberculosis (TB) test result. LPA Brown observed staff files reviewed were complete. Furthermore, two (2) residents medication were audited and LPA Brown observed no issue. In addition, Licensee/Administrator House reported to LPA Brown the facility's liability insurance expired on 02/2024. Deficiency will be issued. An exit interview was conducted where this report (LIC809), LIC809D and Appeal Rights were discussed and provided to Licensee/Administrator Ofelia House.