Routine inspection·November 22, 2023

On 11/22/23, Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with caregiver, Christina Bratton, and introduced self and stated purpose of the visit. LPA was informed that there are 6 residents in care. The facility has 4 bedrooms, 3 bathrooms, kitchen, dining area, living room, entry room, laundry room, garage and backyard. LPA completed a walk through of facility and review of records. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 degrees fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA observed video cameras inside the residents bedrooms. Deficiency issued. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. LPA observed a missing non-skid mat in one of the bathrooms. Deficiency issued. Water temperatures tested at 119.4 degrees fahrenheit. The facility is equipped with operational smoke detectors and charged fire extinguisher. LPA observed non-functioning carbon monoxide alarms. Deficiency issued. Posters such as; the personal rights, ombudsman, CCL complaint poster and disaster plans were posted in a common area. LPA observed the emergency disaster plan on an outdated form. Technical violation issued. Cleaning supplies, toxins, sharps, and other dangerous items were not all kept in secure cabinets. Deficiency issued. There was a designated storage space for resident/staff files. Medications and first aid kit were observed and inaccessible to residents. LPA observed a broken cabinet beneath the kitchen sink and broken counter top. Deficiency issued. LPA also observed the main entrance door with restricted exit access due to code needed in order enter/exit the facility. Deficiency issued. Food Service : Non-perishable and perishable food supply is sufficient. Facility has a wide variety of food available. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with entrance/exit to the facility on the left and right side. All outdoor pathways were free of obstructions. Record Review: LPA reviewed administrator's and staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed incomplete personnel records. Deficiency issued. LPA observed that one staff was not associated to the facility and did not have transfer of criminal record clearance. Deficiency with civil penalty issued. LPA was prohibited to review resident records and was not given access. Deficiency issued. LPA observed through interview with administrator, Teresa Baddeley that the facility did not have an Infection Control Plan. Deficiency issued. Deficiencies, technical violation and civil penalty were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV, LIC421BG and appeal rights were discussed and copies were provided to caregiver, Heilala Poloa who took over the next shift since caregiver's Christina Bratton's shift had ended.