Routine inspection·October 16, 2023

Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to conduct an annual licensing inspection. LPA was met by Jamie Alido, Caregiver, and was granted entry into the facility. LPA spoke with Administrator, James Bandoy by telephone and discussed the purpose of the visit. He authorized Caregiver Alido to conduct the tour and sign off on inspection documents. A tour of the facility was conducted inside and out. LPA, accompanied by Ms. Alido, conducted a general overall inspection, which included but was not limited to the following: Facility physical plant, food service, medication management, record review and facility administration. The facility is licensed to serve six (6) elderly residents, all of whom may be non-ambulatory. A Hospice waiver is approved for two (2) residents. The facility is a five (5) bedroom two (2) bathroom one story house. One bedroom is shared two (2) to a room and the other four (4) bedrooms are private. During today's inspection, LPA observed the following: Indoor and outdoor passageways were observed to be free from obstruction. There are no pools or bodies of water. Per Ms. Alido, there are no firearms or other dangerous weapons in the facility. Poisons and cleaning agents were observed to be secured and inaccessible to residents in care. Facility fire clearance is maintained in conformity with State Fire Marshal regulations. LPA toured every room in the facility. Resident rooms had the required furnishings and sufficient lighting available. Facility provides each resident with clean linen, in good repair, and sufficient hygiene products for personal use. The hot water temperature measured at 107.9 degrees F. The facility had a functioning carbon monoxide detector, multiple smoke detectors, and multiple operable fire extinguishers. The facility was stocked with a two-day supply of perishable food items and a seven-day supply of nonperishable food items. Staff records were reviewed and contained CPR/First Aid training, Health Screening Reports, and annual training. Resident records were reviewed and had a current Physician's Report, Resident Appraisal, Identification and Emergency Information, Admission Agreement, and Centrally Stored Medication and Destruction Records. Medications were stored in a locked cabinet. During inspection of medication, LPA observed the following deficiency: Pre-packaged medication (bubble packaged medication) for R1 and R2 were removed from bubble pack and stored in medication pill trays. LPA advised Caregiver that pre-packaged medication must remain in its original container and cannot be transferred from one container to another. Deficiency cited. This report was discussed with Caregiver Jamie Alido and a copy of this report, LIC809D and Appeal Rights, was provided at the conclusion of the visit.