Routine inspection·July 25, 2024

On 07/25/2024 at 12:20 PM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with Licensee/Administrator Max Zapanta and was granted entry to the facility. At the time of the visit there were two (2) staff present, and six (6) residents present. LPA Brown explained the purpose of the visit to Licensee/Administrator Zapanta. The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, activity room, garage, office and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) can be non-ambulatory residents. The facility has three (3) Hospice Waiver. The current census is six (6) residents. LPA Brown was accompanied by Licensee/Administrator Zapanta to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 113 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. Nightlights were observed in the hallway towards resident bathrooms. ***Continuation in LIC809C *** Also, LPA Brown observed Resident #4 (R4) with half bed rails. Licensee/Administrator Zapanta reported that R4 does have written order from R4 physician indicating the need for half bed rail for mobility. Deficiency will be issued. During the tour of the facility, LPA Brown observed a single bed/mattress in the Office area. Office area used as sleeping room for staff. Deficiency will be issued. Moreover, during the tour of the facility, LPA Brown observed one bottle of laundry soap not locked and accessible to residents in care. Deficiency will be issued. LPA Brown observed sufficient furniture and lighting throughout the facility. There is a cabinet with the resident’s medications locked in the medication cabinet. However, during the tour of the facility, LPA Brown observed medications pre-poured for the whole week for five (5) of six (6) residents at the facility. LPA Brown explained that no medications shall be transferred between containers. Deficiency will be issued. There was a designated storage space for resident/staff files. T Food Service : Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision : The facility has an administrator present in the facility. LPA Brown observed no staff scheduled to work the night shift as required for facility with dementia residents. Deficiency will be issued. Record Review : LPA reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. Residents files reviewed were complete. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA found that Staff #3 (S3) does not have Health Screening Report in S3’s facility file. Deficiency will be issued. Furthermore, during the medication audit, LPA Brown observed Resident #1 (R1), Resident #2 (R2) and Resident #4 (R4) medications were dispensed but R1, R2 and R4 medications administration record was not updated since 07/22/2024. Deficiency will be issued. An exit interview was conducted where this report (LIC809), LIC809D, and Appeal Rights were discussed and provided to Licensee/Administrator Max Zapanta.