Routine inspection·May 9, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Frances Locsin. During the visit, LPA observed 6 residents and 2 staff. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. While touring bathroom #1, LPA observed a container of AJAX inside the shower. ADM stated she was cleaning when LPA arrived at the facility. ADM secured the AJAX in the locked cleaning product storage area during LPA's visit. While touring bedrooms #1, #5 and #6, LPA observed sliding screen doors, with wooden planks on the bottom path, preventing the sliding screen door from opening. (Photographs were taken.) ADM stated it was for double safety. ADM acknowledged that for emergencies the wooden planks would be in the way. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 72 degrees F, and hot water temperature was measured at 109 degrees F in resident bathrooms. Fire extinguisher was serviced in June 19, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit. LPA requested to review the facility fire/earthquake drill log. The facility's last drill was on January 6, 2024. LPA asked ADM to review the drills conducted in the first, second and third quarter of 2023. ADM stated she did do the drills but she threw away the documentation. ADM stated she can not find the drills documentation for the first, second and third quarter of 2023. Page 1 Out of 2. LPA reviewed facility records for 3 staff and 3 residents. LPA requested to review Staff S3's training records for 2023. ADM stated she just removed the records and may have thrown them away. ADM stated she could not find them. LPA reviewed 3 resident medications and centrally stored medication records. LPA observed resident R1-R6's Centrally Stored Medication Log (LIC622) had sections that were not filled out. The sections that were not filled out include the following; Expiration date, Date filled, Date started, Prescription number and number of refills. ADM stated she didn't have ink in her printer. ADM stated she just printed it three days ago. ADM acknowledged she should have filled out the forms before hand. LPA conducted interviews with 1 staff and 2 residents. Deficiencies are being cited during today's visit. This report was reviewed with Administrator Frances Locsin and a copy of the signed report was provided. Appeal Rights were provided. Due to printer error, LPA emailed a copy of the report to ADM. Page 2 Out of 2. END OF REPORT.