Routine inspection·August 11, 2023

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Anchalee Phumirat , Licensee and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). License capacity of (6) with a current census of (6) residents. Hospice waiver for (6). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: LPA inspected the facility inside and out. Indoor and outdoor passageways are free of obstruction. The facility has sufficient lighting and is maintained at a comfortable temperature. Fireplace is adequately screened . Backyard has a swimming pool which is empty and secured with a locked fence, inaccessible to residents in care. Facility has a covered outdoor patio area and self-latching backyard gate. LPA inspected the kitchen. The facility has three (3) refrigerators which tested between 33 to 43 degrees F. Kitchen hot water temperature is maintained at 111 degrees F. Facility has sufficient non-perishable and perishable food supply for the number of residents in care. Facility has sufficient cups, plates, and utensils for resident use. LPA inspected resident bedrooms. Bedrooms are equipped with mattresses, nightstands, pillows, chairs, and storage space. Bedrooms have sufficient linen and lighting. LPA inspected resident bathrooms. Bathrooms are equipped with grab rails and operating in safe and sanitary conditions. The hot water temperatures tested between 109 to 119 degrees F. LPA did not observe a carbon monoxide alarm, Licensee stated that they will obtain a carbon monoxide alarm today (8/11/23). Deficiency cited. Facility has operating telephone service on the premises. Posters such as personal rights, Ombudsman telephone number, complaint telephone number, emergency disaster plan, and emergency phone numbers are posted in a common area. An emergency drill conducted on 7/7/23. Sharps, disinfectants, cleaning solutions, and toxins are kept locked and inaccessible to residents in care. Client medications are kept in a safe and locked cabinet inaccessible to residents in care. All medication are labeled and administered as prescribed. LPA reviewed (3) staff files for First Aid Certifications, fingerprint clearances/exemptions, health screenings, training, employee rights and personnel records. LPA observed staff #1 had incomplete health screening. Licensee stated that they will provide proof of health screening. Deficiency cite. All residents records reviewed had admissions agreements, physician's reports, personal rights: residential Care for the Elderly, record of safeguarded cash resources records. Deficiencies are being cited during today's visit and a plan of correction will be discussed with Licensee. An exit interview was conducted, where this reports (LIC809/LIC809D) were discussed and copies of the reports with appeal rights was provided to the Licensee at the conclusion of the visit. ***This is an Amended report, signed by Licensee***