Facility Evaluation Report

On this day, June 8,, 2023, at 11:25 a.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA was granted entry by staff, Marie Lopez. Mary Pirounakis, administrator, and Margaret 'Rita' Revill, co-administrator, arrived after few minutes. LPA also met with other staff, Perla Ibanez and Michael Revill.

LPA toured the facility with the administrator. LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, 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 February 16, 2023. Facility has 2 in 1 carbon monoxide and smoke detector that was tested and observed functional. Hot water temperature in one the common bathrooms was tested and measured at 108 degrees Fahrenheit. Facility conducts disaster drills monthly, and records showed last conducted May 9, 2023.

LPA reviewed 5 residents and 5 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 the following:

-At 2:50 pm, resident (R1) has no LIC622 Centrally Stored Medication and Destruction Record. Doctor's order for Vitamin D3 is 2000 IU but Medication Administration Record (MAR) showed R1 is given only 1 tablet 1000 IU.

-At 3:30 pm, facility has one medication on facility's hand for resident (R5) but no doctor's order on file.