Post-licensing visit·May 23, 2025

Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced post annual visit. The facility file was reviewed prior to the visit. LPAs were greeted by, identified themselves to, and explained the purpose of the visit Care giver Eduadro Hernandez. Administrator Penelope Pankey later joined the visit. LPA toured the facility and inspected each room of the facility, including resident rooms, bathrooms for resident and staff use, kitchen, common areas, and outside space. 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. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. LPA also observed locked storage for resident medications and resident and staff files. Medications were stored in their original container and locked, made inaccessible to clients. 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. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. LPA reviewed multiple resident records. There were documents missing for all four resident: Resident #1, Resident #2, Resident #3 and Resident #4 and citations were issued during todays visit. (Continued on page 809-C) During the visit, LPA determined that Staff 1(S1) and Staff 2 (S2) was not associated to the facility and did not have an active fingerprint clearance. [Administrator was provided with an LIC811 Confidential Names List to identify S1 and S2 ] Interviews with S1 and S2 and the Administrator revealed that S1 and S2 had been working at the facility for more than 5 calendar days. LPA notified Administrator that S1 could not be present or working at the facility until all was associated to the facility. LPA observed S1 and S2 leave the facility during the visit. The following deficiencies were cited for missing medical assessments, missing admissions agreements, missing pre-placement agreements and for staff without criminal background clearance and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $500 was assessed for staff without a criminal background clearance and noted on the attached LIC421BG form. An exit interview was conducted with Administrator Penelope Pankey , whose signature below confirms receipt of a copy of this report, the LIC811, LIC 809-D's and the LIC421BG and the Licensee Appeal Rights (LIC9058 3/22).