Routine inspection·June 11, 2024

At approximately 10:00 AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced annual required inspection of this licensed senior care facility. LPA was greeted by caregiver, Prima Eudelyn Rabena. Administrator, Rosalina Lubuguin arrived shortly after at approximately 10:20 AM. The facility is a single story home licensed for six (6) non-ambulatory residents, two (2) can be bedridden, and a hospice waiver capacity of three (3). The facility currently provides care for five (5) residents. Four out of five residents were at home and one out of five residents was at a doctors appointment. In addition, there are two (2) residents with a diagnosis of dementia and one resident on hospice. At approximately 10:15 AM, LPA and administrator toured the building and grounds which was found to be clean and in good repair. All notices that are required to be posted have been posted and are in a highly visible area. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins are stored in a locked cabinet in the facility laundry room and kitchen. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water temperature measured within regulation between 112.1 and 114.2 degrees F at three of three faucets accessible to residents. One out of one fire extinguisher was inspected and charged. Eight out of Eight Smoke detectors were present and Carbon Monoxide detector was present, inspected and found to be in working order. There was enough lighting in all common areas, resident rooms, and hallways. Continued on 809C Continued from 809 Medications located in designated cabinet were found to be secured. LPA conducted a spot check of medications and found administering and records to be inaccurate. Resident was observed interacting with staff in bedroom and living room. Two of five residents were found in their room. Two of five residents were watching television .LPA observed staff checking and caring for residents often. At approximately 11:00 AM, LPA reviewed Five of Five resident records which were all found to be well organized. At approximately 12:00 PM, LPA reviewed two out of two staff records which were all found to be well organized. Medication records contained physician's orders for each resident. Administrator Rosalina Lubuguin Administrator Certification is expired, will provide proof of recertification education and application has been submitted. Continued from 809C Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC 500 Personnel Summary LIC 9020 Register of Facility Client’s/Resident's Staff Training Files/Records Updated 602s Evidence of Liability Insurance Evidence of Administrator Certification submission No citations issued during today’s visit.