Routine inspection·July 18, 2025

Licensing Program Analyst (LPA) Rankin arrived at 11:47 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Anna Teresa Tolentino, administrator, 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: Physical Plant & Environment Safety: The fire extinguisher was last charged and inspected on 1/2025. The facility has 5 bedrooms and 2 bathrooms currently occupying 6 residents. The facility has smoke and carbon monoxide detectors that were tested. The lighting is sufficient for the use of the facility and for resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats and or flooring. The pathways are clear of any obstructions. Disinfectants and cleaning solutions are inaccessible to residents in care. The facility has sufficient space inside and outside for activities and visiting. Operational Requirements: The facility has current liability insurance that expires on 1/30/26. The facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 6. Fire clearance is granted for 6 bedridden residents. A hospice waiver is approved for 2 residents. Staffing Records and Training: The facility currently employs 5 full-time caregivers, 1 reliever and 1 administrator, if needed more staff can be pulled from other facilities nearby. Files reviewed had required documentation including but not limited to 1st Aid/CPR, Health screening with TB results, Criminal Record statements, and Fingerprint clearance. Administrator’s Certificate expires 1/16/27. Staff have annual training completed for various subjects/topics and hours for 2024 and 2025. Continued 809-C Resident Records & Incident Reports: Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for, but limited to signed Admission Agreements, Physician reports, Pre-appraisals, Appraisals Needs and Services Plan, all records were complete. 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. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. 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 a sampling of residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts monthly fire drills, last one was in 7/4/2025 and quarterly disaster drills, the last one was 7/08/25. Emergency exits were posted. An emergency pamphlet was provided for future clarification and support. Residents with Special Health Needs: The facility does accept dementia residents in care. 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.