The facility is a seven (7) bedroom, four (4) bathroom home with a kitchen/dining area, living room, activity room and laundry area. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which five (5) can be Non-ambulatory and one (1) bedridden. The facility has six (6) Hospice Waiver. The current census is five (5) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed no obstructions to indoor but obstruction to outdoor passageways was observed as evidenced of old mattress, wooden desk in disrepair and old electric fans in the outdoor passageways during the visit. The facility is maintained at a comfortable temperature of 78 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. However, LPA Brown observed one (1) resident bathroom sink, in disrepair. Deficiency will be issued. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperatures in the bathroom to be at 102 degrees Fahrenheit. Deficiency will be issued. The facility is equipped with operating smoke detectors and carbon monoxide alarms. ***Continuation in LIC809C ***

Furthermore, during the tour of the facility, LPA Brown observed the knives drawer not locked and accessible to residents in care. Deficiency will be issued. Also, LPA Brown observed one (1) sharp scissor and one (1) sharp peeler in the kitchen drawer, not locked with the knives in the knives drawer making it accessible to residents in care. Deficiency will be issued. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication cabinet.

Food Service: Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility.

Care & Supervision: The facility has certified administrators. LPA Brown did not observe sufficient number of staff to provide care and supervision to the residents in care as LPA Brown noted that there's no staff scheduled to work at night shift as required for facility with dementia residents. Deficiency will be issued.

Record Review: LPA Brown reviewed three (3) resident files for admission agreements, updated physician reports, and pre-placement appraisals. The files reviewed were complete. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA found that Staff #1 (S1) does not have Tuberculosis Test Result in S1 file. Deficiency will be issued. Furthermore, LPA Brown observed Staff #2 (S2) working at the facility without criminal background clearance. Deficiency and civil penalty of $500.00 will be issued during the facility visit today and will continue to be assessed of $100.00 per day until corrected. Also, per residents interview, no planned activities for the residents. Deficiency will be issued. Furthermore, LPA Brown observed no fire drill and earthquake drill conducted at the facility. Deficiency will be issued.

During medication audit, LPA Brown observed two (2) of Resident#2 (R2) medications were not given to R2 since 08/01/2024 and no documents at the facility indicating the two (2) medications were discontinued, also LPA brown noted that one (1) medication of Resident #3 (R3) was not given since 08/09/2024 but no document at the facility indicating the medication was discontinued. Deficiency will be issued. Lastly, per staff interview, Staff #2 (S2) reported to LPA Brown that S2 performs glucose testing for Resident #5 (R5) and S2 is not appropriately skilled professional. Deficiency will be issued.

An exit interview was conducted where this report LIC809, LIC809D, LIC9102TA, LIC9102TV, LIC421BG and Appeal Rights were discussed and provided to staff Leni Tayo..