Routine inspection·March 20, 2024

On 03/20/2024 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced 1 year annual inspection visit. LPA met with administrator Maria Diaz and explained the purpose of today's visit. LPA toured the facility inside and outside. Emergency exit routes are free and clear of obstructions. The facility's ambient temperature is comfortable and warm. Water is tested in laundry room as being 108F. Residents have an adequate amount of linens and incontinence supplies, incidental supplies, as well as PPE as needed. Multiple fire extinguishers are observed. Last inspected on 06/22/2023. Upon observation of the charge on the dial display it is within the green zone indicating it is charged and ready for use. Carbon monoxide detectors and smoke detectors are present through out the facility. Fire alarm pull box is located next to the front door and one also near the back near the exit that goes to the backyard. Four client bathrooms were observed to be in good repair. Client bathrooms are observed to be in working order with clean shower curtains and non-skid flooring is in place in client bathroom. Facility provides toiletries for client use. 7 day non-perishable food supply and 2 day fresh food supply is observed as in place. Kitchen is observed as operable and clean. Appliances are in good working order. Knives are stored and locked in kitchen cabinet. Insulin for client use is locked and stored in the main kitchen. There are no residents with dementia in the facility at this time. Continue on next page... Page 2 - LIC809C Medications are stored and inaccessible in a locked medication. Medications are stored and labeled in containers. Medications are reviewed to be in place. Medication administration record is observed as current for clients reviewed including centrally stored medication log. First aid kit is complete and stored in living room area. On site laundry is available and functioning per observations made. Cleaning supplies are observed as locked. 3 staff records are reviewed. All staff has criminal record clearance and are associated with the facility. Based on record reviews, TB tests, training, CPR/First Aid cards, and personnel files are current. 1 client record is checked and is complete and updated. Disaster drills are conducted monthly per records reviewed. According to administrator each drill is different and varies for each drill conducted. Administrator certificate is observed as expired as of 11/12/2022. Per Maria she has submitted items for renewal and is awaiting certificate. LPA reviewed current training hours for administrator certificate. LPA advised Maria to follow up with administrator certification. Per review with administrator client money is in place and accurate. The following updated items are requested to be sent to the Department by 03/27/2024 : • LIC610E Emergency Disaster Plan • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • Updated administrator certificate • LIC9020 Client Roster • Certificate of Liability Insurance • Proof of control of property • Surety bond with expiration date Report is reviewed with administrator.