Routine inspection·April 2, 2025

Licensing Program Analyst (LPA) Rankin arrived at 11:09 am to conduct a 1-year annual visit to the facility above. LPA met Administrator Juanito Pasion 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: Physical Plant & Environment Safety: The facility has 5 bedrooms and 2 bathrooms, with 1 bedroom and 1 bathroom dedicated to staff. The facility is occupying 4 residents and employs 3 staff of which one is the Administrator and two are live in staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors, both were tested and were working at the time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage cabinets. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture. The backyard has a locked shed to store extra furniture and items. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 01/30/2026. The facility is approved for a capacity of 4 non-ambulatory of which 2 may be bedridden. Staffing/Personnel Records & Training: The facility employes 2 staff and 1 Administrator, back-up staff are available when needed. Staff records are kept confidential. LPA reviewed 3 staff files. Files reviewed for 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. All files Continued 809-C were kept up to date with all requirements being met. LPA reviewed training records for Annual Training Requirements, all required annual and new hire initial training was documented. Resident Records & Incident Reports: 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, and Personal Rights.. The facility does handle cash resources for two resident in care. LPA audited cash resources with ledger and cash which was balanced. Incidental Medical & Dental : The facility has a medication cabinet in the family room that is kept locked. Facility provides or assist in providing transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected a sampling of medication and PRN medications. PRN logs and authorization forms were present. No medications labels were altered, no expired medications, and medications were stored in original containers. Food Service: The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Kitchen areas are kept clean and free from litter, rodents, and insects. Disaster Preparedness : The current emergency disaster forms were posted. The facility conducts monthly disaster drills. The fire extinguishers were charged and last inspected 01/13/2025. Emergency exits and telephone numbers were posted. The facility has a sprinkler system. 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 delayed egress. The facility does not currently have residents with oxygen. There are no residents on hospice or home health services at this time. The facility gates are self-closing and self-latching. The backyard is completely fenced. The facility has exiting door alarms, which were working on LPA's visit. Exit interview conducted and copy of report printed for Administrator.