Routine inspection·October 13, 2023

On, 10/13/2023, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection visit for this facility and was greeted by Administrator, John Francoius Delos Reyes. The facility is licensed for all non-ambulatory rooms and a hospice waiver for two. The facility currently provides care for three residents, none of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with Administrator, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility exits were properly equipped with auditory alarms for residents with dementia, tested and found to be in working order. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 6/10/2023. Both smoke detectors and carbon monoxide detectors throughout the facility were interconnected, tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations with food properly stored and labeled. Toxins, sharps and other items that could pose threat if readily available to residents were kept secured in the kitchen, laundry room and garage area. Residents were observed engaging in discussion with staff in common areas and watching television in their bedrooms. Residents appear to have a positive relationship with staff based on LPA observations. Staff were observed continuously assisting and supervising residents and conducting room checks during LPA's inspection. Continued onto LIC809-C There was a supply of hygiene products, continence products, paper products and clean linens available for residents. All resident bedrooms have lighting & appropriate furnishings. Medications are stored in a designated medication cabinet located in the common area and were found to be secured. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA found one prescription for client R2 not properly administered the previous evening of 10/12/2023. Licensee, Administrator and LPA discussed corrections. Technical Violation Issued. A sample file review for staff was conducted and LPA found all staff to have sufficient 1st Aid & CPR certification and annual training on file. LPA also conducted a file review for all residents and found a majority of resident records updated. LPA found resident (R1) physician's report in need of updating. Technical Violation issued. Facility to submitted update facility sketch indicating all bedrooms are non-ambulatory based on current fire clearance. LPA requested the following documents be sent to CCL by COB 11/13/2023: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Control of Property No deficiencies cited during today's visit