Post-licensing visit·June 13, 2023

On 06/13/23 at 8:05 AM, Licensing Program Analyst (LPA) Pang Lee arrived at this facility unannounced to conduct a post-licensing inspection. LPA Lee met with care staff Misivono Qadroka, who then called Licensee/Administrator to informed that CCL is here for a post-licensing visit. Licensee/Administrator Salote Lewis then arrived at the facility. LPA Lee explained the purpose of the visit. Administrator Certificate # 6062098740 expires 08/08/2024. There are currently 6 residents living at this facility. LPA Lee toured and inspected the physical plant inside and outside with administrator to ensure there were no health and safety concerns. LPA Lee observed the front of the building not in good repair. LPA Lee observed the exterior of the home in the from is chipping with a hole. LPA Lee observed the kitchen, bedrooms, bathrooms, and common area. LPA Lee observed the dining table not in good repair. The dining table is not balance and is broken. LPA Lee observed sufficient furniture and lighting throughout the facility. LPA Lee observed the rooms to be clan and organized with comfortable furnishings. The hot water temperature was measured at 119.1 degrees Fahrenheit, which is within the required regulations of 105-120 degrees Fahrenheit . The temperature inside the facility measured at 72 degrees Fahrenheit, which is also within the required range of 68-85 degrees Fahrenheit. LPA Lee observed sufficient seven-day non-perishable and two-day perishable food supplies. Fire extinguishers, smoke and carbon monoxide detectors are in good repair. Fire extinguisher was last serviced on 09/21/2022. LPA Lee checked medication storage and found medication to be locked away and inaccessible to clients. LPA Lee observed chemical toxin made accessible to residents in care. Toxin are kept in the laundry cabinet which is not lock; however the door to the laundry was kept opened and unlock. First aid kit was checked and is complete. Continued on LIC 809-C LPA Lee reviewed 6 out of 6 medication administration record (MAR) and 1 out 6 MARs was complete. LPA Lee requested client and staff files for review. LPA Lee reviewed 6 out of 6 residents files and 6 out of 6 residents files were not complete. LPA Lee also reviewed 3 out of 3 staff files and 3 out of 3 staff files were not complete. LPA Lee reviewed staff criminal record clearances and association and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared but is not associated to the facility. As a result of this Post-Licensing visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC-809 D page. Immediate Civil Penalty were assessed. An exit interview was conducted, and a copy of these LIC-809 reports, LIC 809-D page, LIC-421BG, and Appeals rights were provided to the Licensee/Administrator.