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25 | On 10/12/2023 at 8:05 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with direct care staff, Qalo Saurara and Akuila Saukuru, who then called administrator, Julie Adriana. Administrator arrived approximately 15 minutes later. LPA Lee explained the purpose of the visit. Administrator and care staff assisted with today’s visit. Administrator certificate # is 6038867740 and will expire on 03/03/2024. The current census is 5 with 3 facility staff.
This facility is a single story building licensed to serve six (6) non-ambulatory residents of which one (1) may be bedridden and approved for two (2) hospice waiver. At 10:00 AM, LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed broken glass outside of the courtyard to the left side of the facility, LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. LPA Lee observed resident main bathroom missing a window screen. There are no bodies of water present.
LPA Lee observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 106.5 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers, smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher was last serviced on 11/17/2022. LPA Lee observed the facility has a has a public telephone in the kitchen and the facility have the required posters posted. The facility has infection control plan and has an emergency disaster plan. Facility thermostat observed at 70 degrees Fahrenheit. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA Lee reviewed 3 out of 5 medication administration record (MAR) and it was complete. First aid kit was checked and is complete. LPA Lee requested residents and staff files for review. LPA Lee reviewed 5 out of 5 resident and 3 staff files and they are complete.
Continued LIC 809-C |