Routine inspection (multi-day)·March 12, 2025

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to finish the annual inspection from 2/26/2025. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Caesar Tapit. The facility is licensed for a maximum capacity of 6 residents, 4 ambulatory and 2 non-ambulatory in bedroom # 5. The facility has a waiver for 6 hospice residents. During today’s visit, the facility had a census of 4 non-ambulatory residents, 1 of which was bedridden. During the Required 1-year visit on 2/26/2025, LPA Borunda cited the facility for the fire clearance violation and the facility has a pending capacity increase to address the fire clearance violation. The Administrator for the facility is Laurice Gamab and their certificate was valid and current. During visits on 2/26/2025 and 3/12/2025, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 111.0 and 112.6 degrees Fahrenheit in bathrooms for resident use. The facility’s internal temperature was measured at 78 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Caesar Tapit, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 37 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Continued on LIC809-C page… Staff present at the facility during the time of the inspection had a criminal background clearance and at least one staff had a first aid certificate. LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property, and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. The Administrator will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. During the facility tour, LPA did not observe any grab bars in the shower in the common bathroom. Caregiver Tapit stated that staff currently shower residents in the facility's private bathroom due to the private bedroom being empty. LPA advised Caregiver that when the bedroom is occupied, staff could not shower any residents that did not reside in the attached bedroom in the private bathroom. Therefore, the following deficiency was cited for missing grab bars and noted on the attached LIC809-D page. An exit interview was conducted with Caregiver Caesar Tapit, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).