Facility Evaluation Report

On 05/04/02023 at 10:30am, Licensing Program Analyst (LPA) Arielle Pascua arrived to this facility unannounced to conduct an annual visit. LPA was greeted by Facility Designated Representative (FDR), Sarena Arias and explained the purpose of the visit. LPA asked the FDR Arias call the Facility Designated Administrator to inform them that CCL was present at this time.

This facility is licensed to served 6 residents, all of whom may be non-ambulatory. This facility also has a dementia plan on file and has a current hospice waiver for 6.

Current census was 3. 2 out of 3 residents were out of the facility at the time of the visit.

LPA reviewed 3 resident files. LPA reviewed 4 staff files. 4 out of 4 staff files were complete and up to date. Facility Designated Administrator currently holds an active and current administrator certificate #6019506740 and expires on 08/16/2024.

The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by A.R.F. Fire Extinguisher Co and is valid until 08/26/2023..

The kitchen area was toured. LPA observed a suppy of 7 day non-perishable and 2-day perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in the garage. LPA observed cleaning supplies under the kitchen counter and was not locked and made inaccessible to the residents in care. LPA reminded FDR Arias that all toxins and cleaning supplies need to be locked and made inaccessible.

LPA observed a locked centralized stored medication cabinet located in the laundry room. Along with the FDR, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. LPA observed a large red bottle of pain medication that did not have a prescription order on it. After an interview with FDR Arias was conducted it was learned that the pain medication was given by a family member. LPA informed FDR Arias that all medication needed to have a prescription order along with a label with the resident's name.

Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time