Facility Evaluation Report

On this day, April 21, 2023, at 10:25 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Caridad Sanchez, and informed the reason for visit. LPA also met with other staff, Wilena May Bautista. LPA called, and spoke with Bonnie Jean Tabing, administrator, over the phone who authorized Caridad Sanchez to be with LPA in touring the facility. Administrator arrived at around 11:10 a.m.

LPA inspected the facility inside and out including but not limited to bedrooms, bathroom, laundry and shower room, kitchen, dining and living areas, front, side and backyard. Facility has sufficient perishable and non-perishable foods. Fire extinguishers were observed fully charge with tags showed serviced December 28, 2022. Facility has carbon monoxide and smoke detector that were tested and observed functional. Hot water temperature in the common bathroom was tested and measured at 113.4 degrees Fahrenheit. Facility conducts disaster drills monthly, and records showed last conducted April 16, 2023.

LPA reviewed 5 residents and 4 staff files, and interviewed 2 residents and 2 staff. Medications were checked and compared with records. Residents' cash resources reconciled with records.

During records review, LPA observed resident's (R2) Visit Summary dated 4/07/23 included 3 medications on the medication list but these medications were not on facility's hand. According to the administrator, the medications were not received and administered. LIC622 Centrally Stored Medication And Destruction Record , and Medication Administration Record (MAR) confirmed administrator's statement.