Routine inspection·September 19, 2023

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator/Licensee, Rafael Aquino. There are currently 6 residents in care. This facility is licensed for 6 non-ambulatory residents, with hospice waiver approved for 1 of the resident and none of the residents are approved for bedridden. LPA toured facility and grounds and observed the home organized at a comfortable temperature with all exits free from obstruction. Exit doors have auditory alarms to alert staff. The fire extinguisher located in the kitchen was observed charged but was serviced over a year ago, on 9/3/2022. Fire drill was said to have been conducted by the facility over a year ago and not documented. Water temperature in the resident bathroom was tested and found to be within appropriate range of 105-120 degrees. Bathrooms have required non-skid surfaces and grab bars. Cleaning products and knives are stored in locked cabinets in the kitchen and the laundry room. There was a 7 day supply of non-perishable foods. There are adequate dishes, glasses and silverware. Residents' medications are stored locked. Resident and staff files are located and locked in cabinet. LPA reviewed staff files and staff have proof of CPR/1st aid that expires 4/13/2024. Staff did not have proof of yearly training. Resident files were reviewed and found to have several Appraisals not current or within a year and several residents did not have a current medical assessment. Facility has both yard gates that need repairing, gates should be self closing and latching. LPA went over facility to remove any gadgets that may be used to close the doors, including removal of the front door top latch. LPA went over requirements to have a locked perimeter and approval from the fire department and facility to submit an exception request for review of approval by the department. Continue report see LIC809-C LPA discussed Emergency Disaster Plan and Infection Control Plan. Licensee/Administrator to submit the current following documents by 10/20/2023: · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents · Copy of current Administrator's Certificate · Copy of Liability Insurance · Copy of current facility sketch · Copy of current Lease/Rental Agreement or Property Tax document showing control of property. Due to time restraint, computer issues, and inspection tool Kit getting locked, LPA was unable to complete inspection. LPA will return to issue citations warranted for staff and resident files, no staff training, other areas and review medication. No citations issued at this time. Exit interview conducted with Rafael Aquino Licensee/Administrator.