1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 | On 1/17/2025, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to conduct a required annual inspection. LPA was greeted and granted entry by Caregiver, Ron Lao who was informed of the purpose of the visit. Administrator, Jenny Castellanos arrived during the visit and was also informed of the purpose of the visit. The facility has a fire clearance to serve sixteen (16) non-ambulatory elderly residents, of which eight (8) may be bedridden. The facility also has an approved hospice waiver for six (6) and is approved for a secured perimeter.
LPA toured the facility's interior and exterior with Caregiver, Rosemarie Dela Cruz. LPA observed eight (8) resident bedrooms, four (4) resident restrooms, two (2) living rooms, a kitchen, dining room, and staff office. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. LPA did not observe any bodies of water on the premises. Indoor and outdoor passageways were free of obstruction. The facility met Departmental requirements for a two-day supply of perishable foods and seven-day supply of non-perishable foods, which were stored in a safe and healthful manner. Medications are stored in a locked medication cart secured in the locked medication room. LPA observed additional incontinent supplies, linens, blankets, towels, and hygiene supplies available for the residents in care. Cleaning solutions and knives are secured in different locked storage closets. Facility staff tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility, which were last serviced on 6/29/2024. The facility's certificate of liability insurance expires on 7/1/2025. Staff present have a criminal record clearance and are associated with the facility. LPA reviewed random staff and resident files. Staff files reviewed had a criminal record clearance and valid first aid/CPR certification. Resident files reviewed had updated physician's reports and signed admission agreements. Long Term Care Ombudsman information, complaint procedures, facility sketch, and emergency phone numbers are visibly posted near the dining room. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Castellanos. |