Pre-licensing visit·May 31, 2024

On 05/29/2024 at 8:33 AM, Licensing Program Analyst (LPA) Pang Lee arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lee met with Licensee Chris Faamausili. Licensee assisted LPA Lee in today’s inspection. This Applicant is seeking licensure for a 6-bed non-ambulatory Residential Care Facility for the Elderly (RCFE) to accept and retain at any given time. The facility will have two live in staff. There were no residents at this time. Noel Estilore will be the Administrator of this facility. The facility administrator’s certificate # 6033614740 and will expire 02/09/2025. The facility has an infection control plan and an emergency disaster plan completed and provided to Licensing for approval. LPA Lee toured the facility, and it was learned that the facility sketch did not align with the layout of the building. It was observed that the facility has a staircase closet, four cameras and a detach garage that is not on the facility sketch. LPA Lee observed the front porch a concern to residents in care. Due to the facility seeking licensure for 6 non-ambulatory resident the front porch is a health and safety concerns because the front porch is 24 inches high, and it does not have any rails to prevent residents from falling over. LPA Lee inspected the kitchen area. Cabinets and drawers were opened and reviewed at this time. Silverware, plates, and utensils were observed to be sufficient to meet the needs of the residents at this time. Knives, cleaning agents, and bleach were observed to be locked and made inaccessible to the residents at this time. The food storage unit, facility refrigerator, was observed to be functional and in good repair at this time. Food supplies were reviewed for adequate 2-day perishables and 7-day non-perishable quantities, and they both were observed not sufficient at this time. The two-living area and dining area were observed to be furnished and sufficient to meet the needs of the residents at this time. LPA Lee observed a telephone made available to residents in the kitchen. The facility smoke detectors, carbon detectors and fire extinguisher were observed to be in good condition. The fire extinguisher was last serviced on 03/08/2024. Linen closet was observed sufficient supply of sheets, bedding, pillowcases, and blankets to meet the needs of the residents at this time. Residents’ bedrooms were toured, and furniture and furnishings were observed to be sufficient and able to meet the needs of the residents. The water temperature measured at 115.0 degrees Fahrenheit, and the facility temperature measured at 73 degrees. LPA Lee observed the centrally stored medication areas to be locked. LPA Lee inspected the first aid kit, and it was not complete. First Aid kit was missing a thermometer and a current first aid manual. LPA Lee observed there were no supply of hygiene items on the premises made available to residents in care. LPA lee observed facility has a designated area for residents and staff files, which is kept locked. LPA Lee also observed required posters posted. LPA Lee did not observe activity supplies made available for residents at this time. LPA Lee toured garage and the courtyard. LPA Lee observed the outdoor not equipped for outdoor use. LPA Lee did not observe the courtyard having any furniture made available for residents in care at this time. The emergency exit was unobstructed. · Licensee/Administrator will ensure that an updated plan of operation to include live in staff. · Licensee/Administrator will ensure that an updated facility sketch to include the four cameras in the home, the staircase closet, and the detached garage. · Licensee/Administrator will ensure that the facility has sufficient supplies of hygiene for resident use. · Licensee/Administrator will endure that the facility has sufficient 7 days of non-perishable food and 2 days perishable food at all times. · Licensee/Administrator will endure that the facility has a first aid kit including a thermometer and a current first aid manual. · Licensee/Administrator will ensure that there are activity supplies and equipment made available for residents. · Licensee/Administrator will ensure that there is a rail install/place in the front porch to prevent residents from fall over. The Applicant has not passed the pre-licensing component of the application process. The applicant will correct issues and inform LPA when the corrections have been completed. An exit interview was conducted, and a copy of this report was provided to the Applicant.