Routine inspection·June 21, 2024

Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to conduct a Required-1 Year Inspection. LPA initially met with staff, Maria Butuza, and then with John Butuza, Administrator/Licensee, who arrived shortly to the facility. LPA observed (1) resident present and enjoying lunch and playing cards in the kitchen area. Currently, there is (1) resident. and the resident is not on hospice. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver approved for (1) resident. LPA and Administrator toured the interior/exterior of the facility including common areas, (6) private resident bedrooms, (3) resident bathrooms, staff room, kitchen, laundry and garage. LPA observed the facility to be clean, in good repair and odor-free. LPA observed each bathroom to have the necessary grab bars, non-skid flooring, shower chair, paper towels, trash can with lid and 20-second hand-washing poster nearby. Medications are locked in a designated closet, and all toxins are locked in the laundry area. The inside temperature measured 74*F and the hot water measured 116*F in the kitchen. The fire extinguisher was last serviced 2/12/24. One smoke/monoxide alarm was tested and sounded. There are door alarms on the exit doors. The driveway area is open and unlocked and can be used for emergency exit. All required postings were observed. There is a patio table outside as well as a vegetable garden. Staff records were reviewed for the Administrator and (1) staff. Both have current First Aid/CPR certifications, have completed required training within the last year, and are fingerprint cleared. RCFE Administrator certificate #6016326740- exp 6/3/24 is pending renewal- LPA observed documentation submitted to CCLD. Resident file was reviewed. Physician's report, medication orders and care plan were updated July 2023. Meds are being administered per orders and documentation is current on the LIC622 and Medication Administration Record. Administrator to discuss obtaining prescription orders for vitamins taken regularly and for which there are PRN orders. LPA obtained a copy of current liability insurance. There are no changes to the LIC308 and LIC500 from last year. There were no deficiencies observed. Exit interview. Copy of report and an updated copy of the license (reflecting hospice waiver) was provided.