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25 | Licensing Program Analyst (LPA) Canela arrived unannounced, to conduct an Annual Required 1 YR inspection and was greeted by care staff, Lupo Canilao and Julita Gozos, Administrator, Jean Rice arrived a few minutes later. There are currently 6 residents in care with 2 staff at the time of inspection. This facility is licensed for 6 non-ambulatory residents, with hospice waiver approved for 3 of the residents and no approval for bedridden.
LPA toured facility and grounds and observed all required signs posted in common areas. Infection control practices are present. Facility has a 30-day supply of PPE. Facility was found to be at a comfortable temperature with all exits free from obstruction. Facility has at least two days supply of perishable and one week of non-perishable foods. Fire Extinguishers were fully charged, and have proof of service on 8/7/2023. Water temperature in the resident bathroom was tested and found to be within appropriate range of 105-120 degrees. Exit doors have auditory alarms to alert staff. The bedrooms are all furnished as required. Bathrooms were clean and sanitary with non-skid mats/floors and grab bars. LPA consulted regarding dining room sliding door needing attention, so that the door opens easily. Resident files were reviewed . LPA will return to finish reviewing staff files and residents medication. CPR/1st Aid certificates expiring 5/12/2024. LPA consulted regarding yard gates requiring to be self-closing and latching.
Licensee/Administrator to submit copies of the below documents by 12/10/2023. · LIC 308 Designation of Facility Responsibility
· LIC 500 Personnel Report-
· LIC 400 Affidavit Regarding Client/Resident Cash Resources
· LIC 610E Emergency Disaster Plan
· LIC 9020 Register of Facility Residents
Infection Control Plan of Operation (If changes)
Copy of Liability Insurance- & Copy of Administrator Certificate
No citations issued at this time. |