Facility Evaluation Report

On 08/26/24 Licensing Program Analysts (LPAs) Janette Romero and Debbie Palacios conducted an unannounced visit to the facility for a required annual inspection. LPAs met with the House Manager (HM) Sharon Pajarillaga, who was informed of the purpose of the visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents and an approved hospice waiver for five (5), and LPAs were informed two (2) residents are currently receiving hospice services at the facility.

During today's visit, LPAs observed two (2) staff and six (6) residents present. LPAs toured the facility with HM Pajarillaga and observed the facility is made up of a one-story home with five (5) resident bedrooms, two (2) bathrooms, a staff room, kitchen, dining room, living room, and attached garage. During the tour, HM Pajarillaga tested one (1) of the smoke alarms/carbon monoxide detectors and LPAs observed it to be operational. LPAs also observed a charged fire extinguisher mounted near the kitchen. Indoor and outdoor passageways were free of obstruction. The facility has outdoor shaded seating for the residents in care. There were no bodies of water observed on the premises. Medications are secured in a locked kitchen closet. Resident bedrooms had the required furniture and lighting. Bathrooms had grab bars near the toilets and in the showers. LPAs observed a hallway closet filled with clean linens and towels. The facility had a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Staff present have a criminal record clearance and are associated with the facility. Complaint information is visibly posted near the front entrance.

During a record review, LPAs reviewed Resident 1's (R1's) Physician's Report's (LIC 602A's) dated 6/26/23, 8/3/23 and 5/22/24, which identified R1 as bedridden and unable to independently transfer themselves to and from bed. LPAs also reviewed an LIC 602A dated 7/29/24, indicating R1 is non-ambulatory and unable to independently transfer themselves to and from bed. During the visit, LPAs observed HM Pajarillaga ask R1 to reposition themselves and LPAs observed R1 was unable to reposition themselves in bed. LPA's reviewed R1's Appraisal/Needs and Services Plan (LIC 625) which states R1 is bed bound.