Routine inspection·November 30, 2023

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Administrator, Cornelia Cata and explained purpose of inspection. Also present was Lupe Molina, assistant. Rodrica Madaline Cata arrived at approximately 11:45 am. LPA observed (4) residents in the common area and (2) residents in their resident rooms. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4). LPA and the Administrator toured the interior and exterior of the facility including the common areas, (6) resident bedrooms, each with a half bathroom and (1) full bathroom with a large shower, kitchen, staff rooms and locked laundry area. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps are locked in the kitchen and medications are secured in a nearby cabinet. Toxins are locked in the laundry room. LPA observed sufficient linens/blankets/incontinent supplies, PPE, and a complete First Aid kit. The inside temperature was 69*F. Hot water temperature measured 116*F in the bathroom. Fire extinguisher last serviced 1/6/2023. Quarterly fire drills conducted -last drill Oct 2023. Fire doors (2) are in compliance with regulation. There is an unlocked gate outside and covered seating on the patio. LPA reviewed (3) resident files and found them to be complete and contain current paperwork. Medications were reviewed for (2) residents and no discrepancies were noted. Medication documentation is current and accurate. (2) staff files were reviewed. Both staff have current First Aid/CPR on file. Administrator of record has current RCFE Administrator certificate valid through 3/14/25- #6025206740. Second staff will be renewing her Admin certificate by 12/21/23 (exp). LPA reviewed the Infection Control Plan (LIC9282) and found it complete. Emergency Disaster Plan was reviewed also. Discussed updated forms. LPA obtained updated copy of liability insurance. LIC308 and LIC500 due by 12/8/23. There are no deficiencies issued but there is a Technical Advisory Note being issued. Exit interview. Copy of report provided.