Routine inspection·April 16, 2024

At 8:00 am on 04/16/2024, Licensing Program Analyst (LPA's) Rankin and Jeffries arrived to the facility unannounced to conduct the annual facility inspection. LPA's met with Licensee's Joyce and Joseph Cabandong announced who they are and the reason for the visit. Licensee and LPA's conducted a full facility physical inspection. LPA's noted that this is a 6 bedroom , 3 bathroom, den, two living room area's, dining room and kitchen. Medications are locked in two cabinets in the kitchen area and staff and residents records are kept in a locked cabinet in the den. LPA's tested smoke detectors and carbon monoxide detectors to all be in working condition. LPA's observed the garage door to be locked however one of the locks required adjustment. LPA's noted that all resident bedrooms had required furnishings and bedding by regulations. LPA's noted that the facilitates water temperature was with in regulations temperature. LPA observed at least two days of perishable and at least 7 days of non-perishable foods on hand for 6 residents and staff. LPA's conducted a staff and resident file review. LPA's conducted a sample medication audit. LPA's noted that Centrally Stored Medication Record (CSMR) was missing and two needed updating, this was addressed in the care tools modules. LPA's noted that the facility was clean and in good repair. LPA noted that all passageways and doors were clear of obstacle and debris. LPA's noted that both fire extinguishers observed were pressurized and in the green reading. Licensee and LPA's conducted a full review of the annual care tools modules. LPA's note two citations during the care tools module. Administrators certificate was expired. LPA's address expired certificate with Licensee as requiring additional hours for completion and current administrators certificate. The second violation as noted above, CSMR was missing and not updated, this resulted in a citation and required mitigation with in 24 hours. LPA noted that no other citations were issued as a result of this annual facility inspection. Exit interview, report read, appeal rights provided, and report provided.