Routine inspection·October 24, 2024

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection visit at 9:15AM and met with Administrator, Helen Ibrahim. LPA toured the facility inside and out with the Administrator to include the living room, dining room, kitchen, resident bedrooms, bathrooms, and exterior. All emergency exits were observed to be clear of obstruction. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature maintained at 40 degrees F and freezer maintained at -0 degrees F. LPA observed toxins, sharps and chemicals locked and inaccessible to residents. LPA toured 5 resident bedrooms. 5 out of 5 resident bedrooms had beds, a dresser, functioning lights, storage space for personal belongings, clean bedding, and a chair. LPA measured hot water temperature, range of 105.2 to 112 degrees F for 2 out of 2 resident bathrooms. The facility was equipped with smoke and carbon monoxide detectors. Fire extinguishers were last serviced on 03/13/2024. LPA observed the facility first aid kit, and it was observed to be complete. The facility fire/earthquake drill log was reviewed, and drills are being conducted quarterly. The last fire drill was conducted on 09/2/2024. Facility has emergency disaster plan. LPA reviewed 5 residents Centrally Stored Medication and Destruction Records (CSMDR). 5 out of 5 residents CSMDRs are complete with all medications accounted and documented. LPA observed the medication storage area was locked and inaccessible to residents in care. LPA reviewed 5 out of 5 resident records. LPA observed 5 out of 5 resident records to contain identification and emergency contact information, personal rights, TB results and consent forms. 2 out of 5 Residents (R4 and R5) records did not contain updated physician's reports. Administrator stated the R4 and R5 had a physician's reported updated on 10/23/2024. Administrator stated she will obtain the updated reports from the physician. Administrator states she was updating residents charts. LPA advised Administrator that all resident records should be available to the licensing agency to inspect and audit. Administrator stated the physician's reports were updated on 10/23/2024 and would obtain the updated reports by 10/29/2024. LPA reviewed 3 out of 3 staff records. LPA observed 3 out of 3 records as complete to include fingerprint clearance, health screening, TB result, personnel record, and staff training. A Technical Assistance was issued today. See LIC809D. Exit interview was conducted with Administrator Helen Ibrahim. This report was provided to Administrator and appeals rights were provided.