Routine inspection·January 27, 2025

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, Required Annual Inspection. The facility file and personnel report was reviewed prior to the visit.  LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Mike Polinario. Administrator Nelly Panao joined later in the visit. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. The facility is approved for one (1) hospice resident. During today’s inspection there were two (2) residents in care. LPA and Caregiver Polinario toured the interior and exterior of the facility and inspected each room. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink was 105F and kitchen tap read at 116F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food. During the tour, LPA noticed evidence of rodent activity in the pantry area. Cooking, dining equipment, and utensils were present. No toxic chemicals, poisons, or knives were accessible to clients. During the tour, LPA noticed two cups of unsecured medications left next to the dining table. Interviews with staff and Administrator Panao revealed the medications are pre-poured for a resident as only the Administrator holds a key for the medication cabinet. Aside from those doses, medications were labeled, as required, and stored in locked areas. [Continued on LIC 809-C...] [Continued from LIC 809...] No pools or bodies of water exist on the premises. Per caregiver Polinario, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher was serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed two (2)  staff and two (2) clients, and interviews did not reveal licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained some of the required documents, and LPA discussed with Administrator Panao of necessary documents. Confidential records were stored in locked areas. Deficiencies were cited during the inspection for unsecured medications and the presence of pests. An exit interview was conducted with Administrator Panao to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. Their signature below confirms receipt of these documents.