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25 | Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual.
LPA met with Gideon Castro, Administrator and Elena Castro, caregiver, and explained purpose of inspection. Also present were caregivers, Teodorico Santos and Gina Taganahan. LPA observed (1) resident to be visiting with a family member in the common area and (3) residents to be resting in their rooms. The facility is located away from the main street and is up on a hill with a view. There are no neighbors in close proximity. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3). Currently, there is (1) resident under hospice care.
toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (6) private resident bedrooms, (4) resident bathrooms, kitchen, laundry area and (2) staff rooms on the second floor. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. There is sufficient 2+day perishable, including fresh produce, and 7+day non-perishable supply of food. Sharps, medications and toxins are locked in/near the kitchen. The inside temperature measured 76*F and the hot water measured 105*F in resident bathroom. The smoke/monoxide alarms are working and quarterly drills are conducted. There are sufficient linens/towels/blankets and paper supplies, including PPE. Each resident room has an exit to the backyard and there is main parking gate near the front entrance. There are no pools/ponds.
LPA reviewed (2) of (4) resident files and found them to be organized and contain current physician's reports and appraisals. Medications were reviewed for (1) resident- orders matched medications administered and MAR documentation is current. LPA reviewed (5) of (9) staff files and found them to be complete and contain current training documentation, including for First Aid/CPR. RCFE Administrator Certificate #6016577740- exp 5/19/24- renewal has been initiated. All staff is cleared and associated. LPA requested an updated copy of the LIC308, LIC500 by 4/25/24. Copy of current liability insurance was obtained. There are no citations issued. Exit interview. Copy of report provided. |