Routine inspection·March 11, 2025

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual visit of the facility. LPA was welcomed by staff Glenda Castle. Georgiana R Santos Licensee/Administrator was contacted by facility staff on the telephone and wasn’t able to be present for this visit, LPA spoke with Licensee authorizing staff to sign documents. RCFE is a single story 6 bedroom, 3 bathroom with fire clearance for six Non-Ambulatory of which 3 may be bedridden in rooms 2, 3, & 4 and Hospice Waiver for 3. There is currently a total of 6 residents, 4 with diagnosis of dementia, one resident on hospice. Facility tour/inspection began at 1:10 PM: LPA toured the facility with staff Glenda; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices that were working properly during time of visit. Fire Extinguisher was found to be last charged on 1/24/2025 at the time of the visit. Smoke/carbon monoxide detectors are hard wired throughout facility, last inspected by Fire Dept. 2/25/2025. Hot water temperature measured 105 degrees F and 107.2 degrees F in 2 out of 2 resident bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Sharps/knives are stored in locked container on kitchen counter, toxins are stored in the garage in a locked laundry cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower, although at this time there is a shower wheelchair most residents are currently sitting in while being bathed in the shower. All bedrooms have lighting & appropriate furnishings. Continue on LIC809-C Continued from LIC809 File Review began at 2:00 PM: A review of five resident & four staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files and learned 5 out of 5 resident resident records reviewed have updated re-appraisals/needs & care plans and 5 out of 5 residents have current physician’s reports. All files are current. LPA reviewed a sample of staff records and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff annual training requirements for 2024 are on file. LPA was presented with proof of CPR & 1 st Aid certification for staff that files were reviewed. Medications were centrally stored in locked cabinet in the facility office room area. Facility has a 30-day supply of medication for residents. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. Administrator Certificate for Administrator, Georgiano Santos 7005931740 expires 8/25/2026. Last Disaster Drill was conducted on 2/6/2025. Disaster drills are to be conducted quarterly and in different shifts. No Citations given at today's inspection Exit interview conducted with Designee. LPA Hansen is requesting facility to submit the following documents to CCL by 3/25/2025: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Current Administrators Certificate Copy of Certificate of Liability Insurance