Routine inspection·July 7, 2023

On July 7, 2023, Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived unannounced at the above facility to conduct a required annual inspection. LPA Shaw Ross was greeted and granted entry by Caregiver, Brenda Catap. LPA Shaw Ross introduced self, and stated the purpose of the visit. Administrator, Elizabeth Rivera joined shortly. An overall tour of the facility was conducted inside and out. The facility is a one story, five (5) bedroom, three (3) bathroom home. At the time of the visit, five (5) clients and two (2) staff were present. LPA observed one (1) bedroom that is shared by two clients and remaining bedrooms are private. All bedrooms were clean and appropriately furnished. Furniture in the home is in good repair. Outdoor space is free of hazards. LPA observed a small room used for overnight staff and a small designated office area next to the kitchen. The facility appeared clean and free of odors throughout. All smoke and carbon monoxide detectors were tested and found operational. Food supplies are sufficient. Emergency food and water was stored in the kitchen. Hot water temperature was measured at 113 degrees Fahrenheit. LPA observed all toxic chemicals and other hazards secured and inaccessible to clients. Medications are centrally stored in a locked closet in the hallway. LPA inspected medications and during the inspection, the LPA observed the following deficiency: - The facility had medication on hand, such as, Ferosul- the facility did not have said medication on MAR list. LPA inspected the staff and client records. Staff files had criminal record clearances and the required documentation including First Aid Certifications and training documents. Client records contained required documents and current information. The facility is completing emergency drills on a quarterly basis. Staff and client interviews was conducted. Based on observations made by LPA, the facility was cited and a deficiency was noted on LIC809D. An exit interview was conducted with the Administrator Elizabeth Rivera and a copy of this report, LIC809D, and appeal rights was provided.