Routine inspection·November 22, 2024

Licensing Program Analyst (LPA) LaVette Farlow arrived unannounced to conduct the required annual visit to the facility. LPA met with Caregiver, Roldan Kiseo, and introduced self and stated purpose of the visit. Caregiver Roldan notified Administrator of my arrival and state the house manager will be arriving to the facility. LPA met with Carmen Holden and explain the purpose of the visit and a tour was conducted. LPA was informed that there are currently 5 residents in care and (1) resident in the hospital. The facility has 5 resident bedrooms, 3 bathrooms, kitchen, dining area, living room, attached garage, and backyard. LPA completed a walk through of facility, review of records and medication audit. 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 75 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 107.2, 105.2, 109.1 and 107.7 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, 3 fire extinguishers and emergency kit. Posters such as; the personal rights, ombudsman and emergency disaster plans were posted in a common area. LPA observed cleaning supplies, toxins, sharps, and other dangerous items locked in cabinets made inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed in a secured filing cabinet and inaccessible to residents. LPA observed two (2) out of two (2) residents MARS were not properly initialed. Technical violation issued. There are no firearms, ammunition, swimming pool or bodies of water. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service : LPA observes that the facility did not maintain a sufficient amount of non-perishable and perishable food supply for 7 days for number of residents in care. Technical violation issued. Dishes, cups, and utensils were also stored properly. Yards/Outside: Two shaded patio, a side gate with self-latching handle on the right and left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. LPA observed the Emergency Disaster Plan not signed and dated. Technical violation issued. LPA observed emergency drills not conducted on each shift. Technical violation issued. Three technical violations were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, and LIC9102TV were discussed and copies were provided to Administrator Shreeta Yadav.