Routine inspection·February 15, 2024

Licensing Program Analyst (LPA) Miller arrived at 8:00 a.m. to conduct a one-year annual visit to the facility above. LPA met with Administrator, Jason Caluya, and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 3 resident bedrooms, and 2 bathrooms. Facility currently occupies 2 residents and employs 3 full time staff, one of which is the Administrator. LPA Miller was authorized to enter and inspect facility. The facility had a smoke and carbon monoxide detector that was tested and working properly during visit. Fire extinguishers were purchased on September 14, 2023. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions are inaccessible to residents in care locked in cabinet above washer and dryer. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use and front patio has plenty of shade thought the use of canopies and umbrella shades. The facility has telephone and internet service for resident use. Continued on 809-C Incidental Medical and Dental: LPA Miller conducted a review of prescriptions for two residents. Resident 1 was given 100 Mg Tablet of Metoprolol Succinate, despite being expired since September 30, 2023 and Triamcinolone Acetonide .1% topically cream, despite being expired since September 2023. Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on June 1, 2024. The facility is approved for a capacity of four. The fire clearance is granted for 4 non-Ambulatory. Hospice is approved for one. Staffing: The facility currently employes 3 full time staff, one of which is the Administrator. Staff files were reviewed. Current Administrator Certificate expires July 15, 2025. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed two resident files for signed Admission Agreements, medical assessments and appraisal & needs service plans. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and extra, to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Disaster Preparedness: Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility currently has two residents receiving Home Health services. Exit door alarms are working. Exit interview conducted, copy of report provided.