Routine inspection·August 21, 2025

Licensing Program Analyst (LPA) De Leon arrived at 10:00 am to conducted a 1 year annual visit to the facility above. LPA met with Licensee/Administrator Janelyn Castaniaga and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, hand dryer, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms when and if needed. Physical Plant & Environmental Safety: The facility is a 5 bedroom home. Three double bedrooms with 2 on suite bathrooms and 1 common area restrooms dedicated for residents use. There is master bedroom and bath dedicated to a single resident and 1 other staff bedroom. The facility has 4 residents in care and employs 2 regular staff, 1 administrator and 2 back up staff on call when needed. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. The kitchen has a gate to make the range inaccessible to dementia residents, and it does not lock. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents locked in the laundry room and locked garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a back/side yards for resident use with furniture and plenty of shade. Telephone and internet service is provided for resident use. The facility has a working washer and dryer. Continued 809-C Operational Requirements: The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance expires 05/01/2026. The facility is approved for a capacity of 6 Non-Ambulatory and a Hospice waiver approved for 4. Staffing: The facility employes 3 staff, 1 Administrator and 2 back up staff when needed. Staff records are kept confidential. LPA reviewed 4 staff files for Application, finger print clearance, transfer or exemptions and Health screening with TB results. LPA verified administrator file to have current 1st Aid/CPR. and Administrator Certificate expires 10/22/2025. Personnel Records & Training: The facility keeps confidential files for each staff member. 4 staff files were reviewed for initial and annual training requirements. Staff hired in 2025 had 40 plus hours of training meeting regulation requirements and staff hired prior to 2025 had 20 plus hours of annual training for 08/2024-08/2025 meeting regulation requirements. Resident Rights & Information: All require postings were posted in the common area of the facility. Personal rights, Rights to Resident Council, Theft and Loss policy, and Non-discrimination notice. CCL Complaint poster and LTCO poster were posted in the common areas of facility. The current license is posted. CCL reports are posted. Internet is provided to residents in care, confidentiality and privacy is given. Planned Activities: The facility has supplies for activities. The residents currently in care watch TV, go for walks, have discussions with staff and exercise a few days a week. The residents said they do what they want to do. 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. Food, snacks and drinks are available when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Continued 809-C Incidental Medical and Dental: Facility provides 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). Medications for all resident in care are centrally stored. LPA reviewed medications and records. No medications label were altered, no medications were expired, and all medication was stored in original containers. Medication are given as prescribed by physicians orders. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Four files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. 1/4 residents was in need of an up to date Appraisal Needs and Services Plan (ANS) and all other forms were up to date. Pre-Admission appraisals and functional capabilities assessments are conducted on perspective residents before accepting them into care. The Facility does not handle cash resources for any of the residents in care. Facility does submit incident reports to the department when required. Disaster Preparedness : The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. 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. Facility has emergency food and water supply, flash lights with batteries, and a cooler with ice packs for medications. The facility has several evacuation sites. The facility has a back up generator if needed. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have any resident on oxygen. The facility currently has 1 resident receiving hospice services. The facility currently has no residents receiving home health services. Hospice care plans are kept on file and up to date. The facility does not have any delayed egress. The facility has alarmed exiting doors and gates. The facility has three self latching, self closing gates with alarms. There are no bodies of water on the premises. LPA conducted interviews with 1 staff and 1 resident. Exit interview conducted, deficiency cited, copy of report printed and appeal rights printed for Licensee/Administrator.