Routine inspection·May 1, 2025

On 05/01/25 Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with care staff Helen Agbiriogu and Irene Iberi and explained the purpose of the visit. Care staff called the facility designated administrator (FDA) Joyce Diala to informed that CCLD was present in the facility. FDA arrived approximately an hour later. Care staff and administrator assisted with today’s visit. Administrator certificate # is 6035237740 and will expire on 08/05/25. The current census is 5 with 2 facility staff. The facility is a single-story building licensed to serve six (6) residents. Rooms 1 and 3 are approved for non-ambulatory residents, while room 2 is designated for ambulatory residents only. LPA Lee conducted an inspection of the physical plant, including but not limited to the common areas, kitchen, dining area, resident bedrooms and bathrooms, laundry room, garage and outdoor courtyards, to ensure compliance with Title 22 regulations. The facility was observed to be clean, odor-free, and in good repair. Resident bedrooms were properly furnished with appropriate bedding and adequate lighting. No bodies of water were observed on the premises. During the kitchen tour, LPA Lee observed a sufficient supply of food, including a seven-day supply of non-perishable and a two-day supply of perishable items. The hot water temperature in the resident bathroom sink measured 110.3°F, which falls within the regulatory range of 105°F to 120°F. Grab bars and non-slip mats in the bathrooms were secure and in good condition. Smoke and carbon monoxide detectors were found to be operational and in compliance with fire safety requirements. The facility's fire extinguisher, located in the hallway, was purchased on 10/27/24. Per administrator Diala, the last fire drill was conducted on in April 2025 and that it was not documented. LPA Lee advised that fire drill needs to be conducted every 3 month and should be documented. Continued LIC 809-C A public telephone is available in the common area, and all required documents and postings were visibly displayed; however, LPA Lee observed PUB 475 poster is not the correct sized and LPA Lee advised administrator that the poster needs to be in the size of 20” by 26”. The facility thermostat was set to 73°F at the time of the inspection. Toxic cleaning agents were stored in a locked hallway closet, inaccessible to residents. Sharp knives were observed secured in a locked cabinet. Medications were stored securely and were inaccessible to residents. LPA Lee reviewed medications for all six (5) residents and verified that the medication administration records (MARs) were complete and accurate. The first aid kit was inspected and contained all required supplies. Resident and staff files were requested and reviewed. All six (5) resident files were found to be complete. LPA Lee reviewed staff 1 (S1)’s file and it was not complete. S1 did not have current 20 hours of continual training, and first aid/CPR certificate had expired. LPA Lee requested to review the administrator’s file, and it was learned that the administrator’s file is not at the facility; therefore, LPA Lee was not to review the administrator’s file. A review of staff records confirmed that all individuals requiring background checks were fingerprint cleared and associated with the facility. The following documents will be email to LPA by 05/08/25 end of day 5:00 PM: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with administrator Diala and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.