Land of Peace 6

Type of visit: Required - 1 Year

At 2:50 p.m. on 07/31/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility was last visited on 07/14/2022 for a complaint visit. It is a single story building with 6 bedrooms, 3 bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 5 may be non-ambulatory and 1 may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for 6. The facility uses surveillance cameras on the exterior and interior. Entry: Upon entry, LPA observed posting for facility’s visitation policy. The front yard was maintained. Screening: LPA was screened for infectious disease upon entry. The screening station contained visitor log, hand sanitizer, and digital thermometer. Visitor log tracked contact tracing information, temperature, symptoms, and vaccination status. Bedrooms: The facility has 6 bedrooms. 5 are private and 1 is shared. Bedroom #2 is designated for staff. No hazardous objects were present. Bedroom #3 is shared. Beds were at least 6 feet apart for social distancing. Bedroom #4 contained a bed with full bed rails. Bedroom #5 contained a bedridden resident. The exit was unlocked and free of obstructions. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bathrooms: The facility has 3 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. Bathroom #1 contained two showers in good condition. At 2:55 p.m. LPA measured the water temperature in Bathroom #1 to be 114.6 degrees Fahrenheit. Kitchen: LPA observed an adequate supply of perishable and non-perishable food. The stove and hood were clean. Sharps were locked by the stove. Medications were locked above the counter top. Laundry: LPA observed a dryer and washer in good condition. Detergents were locked. A fully-charged fire extinguisher was located near the laundry room. A receipt from 05/03/2022 was attached to the extinguisher. Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 3:21 p.m. LPA measured the room temperature to be 76.4 degrees Fahrenheit. LPA observed board games, casino games, and activities in the dining room. Seating was arranged to accommodate social distancing. Safety: All emergency exit paths were free from obstructions. All exits were unlocked. Emergency Disaster Plan posted at the front. Evacuation routes clearly labelled and posted in each bedroom. Fire sprinklers located throughout the facility. 5 out of 5 auditory alarms were detected during the visit. Outdoor areas: LPA observed a covered patio area outside of Bedroom #6. All handrails were secure. The back yard was maintained. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 31, 2022

Allegation investigated: Resident sustained an open wound while in care

Licensing Program Analyst (LPA) conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegation. LPA met with Roselin Finuliar and explained the reason for the visit. LPA conducted physical plant tour at 12:45 PM, requested copies of facility documents relevant to the investigation at 1:00 PM. Regarding the allegation that that resident sustained an opened wound while in care, it was alleged that Resident #1 (R1) was found with an open wound upon release from the hospital. LPA's record review on 07/15/22 at around 12:30 PM revealed that there was no indication that R1 had a wound prior to hospitalization on 11/06/21. LPA's interview with the administrator on 07/15/22 at 11:34 AM also revealed that it was her who saw the wound on R1 when R1 went back to the facility upon release from the hospital on 11/11/21 and reported it to the family member, CCL and primary care physician (PCP) and requested a wound care specialist to evaluate the wound. (continued on LIC 9099-C). Unsubstantiated (continued from LIC 9099) Further record review also revealed that Home Health nurse only visited on 11/21/21 for a wound assessment and found that the injury was closed and that there was no need for a follow up evaluation. Based on the information gathered during this and prior visits, there is insufficient evidence to support the allegation and therefore deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 14, 2022 · control 31-AS-20211118110648

Type of visit: Required - 1 Year

At 11:25am Licensing Program Analyst (LPA) Angela Panushkina, conducted an unannounced annual inspection at the above facility. LPA met with the caregiver Emma Dizon who granted access to home. Shortly after, around 11:45am, the Administrator arrived. LPA toured the entire facility with the Administrator and observed the following: This is a 6 bedroom, 3 and 1/2 bathroom, single story family residence that includes a living room, dining area, kitchen, laundry room and attached garage. Infection control: LPA Panushkina reviewed facility mitigation plan (approved on 01/29/21) to make sure licensee was following current infection control recommendations. There are required posters posted at the main door. LPA was screened upon entry. Screening area is located in the living room area. Sign in sheet, hand sanitizer, gloves and masks are available. All staff were observed to be wearing mask upon entrance and during visit. Food Inspection: At 12:00pm LPA conducted a food inspection tour an found the following. Supplies of staple non-perishable for minimum 1 week and perishable for 2 days maintained on premises. In between meals snacks is available in the facility. The kitchen knives were observed locked and inaccessible to residents in care. There is one carbon monoxide detector in the hallway by the living room area. Smoke detectors were checked and are hardwired throughout the facility. Smoke detectors and carbon monoxide are observed to be operational. Bedrooms: There are five bedrooms designated for residents' use and have sufficient lighting and one bedroom is designated for live in staff. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms are in good repair and operating properly. Bathrooms: At 12:20pm LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 116.3F. LPA observed appropriate grab bar and all showers had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had lids. Common Areas: The facility maintains a comfortable temperature at 76F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. There is a fire extinguisher in the laundry area and was last serviced on 05/13/21. Surrounding Grounds: LPA toured the outside area of the facility. There are no bodies of water. There are no visible hazards, and passageways are free from obstruction. Gate was unlocked and easily accessible to open. LPA observed appropriate outdoor furniture, with a covered shaded area for the residents. The garage is attached to the home and is kept locked inaccessible to residents. Medications: Centrally stored medications kept in a safe locked place that is not accessible to persons other than employees responsible for the supervision of the medication. Administrative: LPA collected Certificate of Liability Insurance, Administrator Certificate and LIC.500. Annual fees are current. Exit interviewthe state’s words, verbatim · CDSS document, Jul 23, 2021