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 04/29/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA met with staff member (SM), Noralyn Calabines and explained the purpose the visit. LPA asked the SM Calabines call the Facility Designated Administrator (FDA), Tabitha Antonia to inform them that CCL was present at this time. Shortly after, LPA met with FDA Antonia and explained the purpose of the visit. One other staff member was present, Grace Lee.
This facility is licensed to serve and retain 6 residents who are 60 or older. All of which may be non-ambulatory. This facility also holds a Dementia Program on file and has a Hospice Waiver for 6.
Current census was 4.
LPA reviewed 4 resident files and 3 staff files. All files were current and up to date. The administrator has an expired administrator certificate however the LPA was able to verify that the administrator was able to send in the required documents prior to their expiration. The administrator is currently awaiting the department for a renewed certificate.
LPA Pascua observed a locked centralized stored medication cabinet located in the dining room. Along with Administrator, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components.
LPA conducted a tour of the facility.
The fire extinguisher, located in the kitchen area, was serviced by Jorgenson Company on 01/19/2024. Carbon Monoxide and fire alarms were present and in good repair.
Common areas for resident use were toured. Furniture and furnishings were observed to be present and in compliance.
A tour of the bathrooms was conducted. Hot water temperatures were taken to ensure that the hot water being dispensed was within the allowed range of 105-120 degrees at this time. Grab bars were present and functional.
Resident bedrooms were toured. Furniture and furnishing were observed to be present and in good condition.
A linen closet was located in the hallway. LPA observed a sufficient amount of linens at this time. |