Routine inspection·May 22, 2024

Licensing Program Analyst (LPA Miller) arrived at 10:11 am to conduct a one-year annual visit to the facility above. LPA met with Administrator Evelyn Florentino 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: Infection Control: The facility has a current Infection Control Plan. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectant sprays and cleaners. The facility has a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: The fire extinguisher was last charged and inspected on November 7, 2023. All trash cans and wastebaskets have tight fitting covers. The facility has 3 resident bedrooms and 2 bathrooms currently occupying 3 residents. LPA was authorized to enter and inspect the facility. The facility has a smoke and carbon monoxide detector that was tested. 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 as they are locked and stored in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use and a front patio for client use, with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on October 18, 2024. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-Ambulatory, of which 1 may be bedridden in bedroom #2. Hospice is approved for 3. Staffing: The facility currently employs 2 full time staff, 3 part time staff and 1 administrator. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. 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 3 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plans, Emergency and ID forms, all forms were legible and records are kept confidential. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7 day non-perishables 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. Cleaning solutions and equipment are stored separately from food supplies. Continued 809-C Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed resident medications; no labels were altered. However, resident medication of Metformin was expired effective 9/16/23 and Administrator immediately called family to get a current refill. In addition, three (PRN) medications for another resident were logged in the CSMR, but not logged in the MAR. Administrator advised the medications were properly given, but not recorded. Administrator will notate the file. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill April 1, 2024. 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 has 2 self latching gates on side of the home. The facility currently has 1 hospice residents in care. The facility currently has 3 residents receiving Home Health services. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report printed for Administrator.