Mydor's Open Guest Home IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 10:54 am to conduct a 1-year annual visit to the facility above. LPA met Administrator Juanito Pasion and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 5 bedrooms and 2 bathrooms, with 1 bedroom and 1 bathroom dedicated to staff. The facility occupies 4 residents and employs 4 staff of which one is the Administrator and two are live in staff and on call staff are available if needed. The facility has smoke and carbon monoxide detectors; both were tested and were working at the time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. The facility kitchen is clean, safe and sanitary. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage cabinets. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture. The backyard has a locked shed to store extra furniture and items. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 12/30/2026. The facility is approved for a capacity of 4 non-ambulatory of which 2 may be bedridden. Staffing/Personnel Records & Training: Staff records are kept confidential. LPA reviewed 3 staff files. Files reviewed for current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. All files were kept up to date with all requirements being met. LPA reviewed training records staff are newer and had all required orientation records. Continued 809-C Resident Records & Incident Reports: Four files were reviewed for required documents including but not limited to Annual Needs and Servicers review and updated Physician Report. The facility does handle cash resources for three residents in care. LPA audited cash resources with ledger and all records balanced. Incidental Medical & Dental: The facility has a medication cabinet that is kept locked. Facility provides or assist in providing transportation to medical and dental appointments when needed. A sampling of medications records were reviewed. All residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). No medications labels were altered, no expired medications, and medications were stored in original containers. Food Service: The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Disaster Preparedness: The current emergency disaster forms were posted, LPA reviewed and collected current copy of plan. The facility conducts monthly fire drills and quarterly disaster drills. The fire extinguishers were charged and last inspected 02/25/2026. Emergency exits and telephone numbers were posted. The facility has a sprinkler system last inspected on 6/19/2025. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does not currently have residents with oxygen. There are no residents on hospice or home health services at this time. The facility gates are self-closing and self-latching. The backyard is completely fenced. The facility has exiting door alarms, which were working on LPA's visit. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rankin arrived at 11:09 am to conduct a 1-year annual visit to the facility above. LPA met Administrator Juanito Pasion and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 5 bedrooms and 2 bathrooms, with 1 bedroom and 1 bathroom dedicated to staff. The facility is occupying 4 residents and employs 3 staff of which one is the Administrator and two are live in staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors, both were tested and were working at the time of visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage cabinets. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture. The backyard has a locked shed to store extra furniture and items. Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 01/30/2026. The facility is approved for a capacity of 4 non-ambulatory of which 2 may be bedridden. Staffing/Personnel Records & Training: The facility employes 2 staff and 1 Administrator, back-up staff are available when needed. Staff records are kept confidential. LPA reviewed 3 staff files. Files reviewed for 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. All files Continued 809-C were kept up to date with all requirements being met. LPA reviewed training records for Annual Training Requirements, all required annual and new hire initial training was documented. Resident Records & Incident Reports: Four files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, and Personal Rights.. The facility does handle cash resources for two resident in care. LPA audited cash resources with ledger and cash which was balanced. Incidental Medical & Dental: The facility has a medication cabinet in the family room that is kept locked. Facility provides or assist in providing transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected a sampling of medication and PRN medications. PRN logs and authorization forms were present. No medications labels were altered, no expired medications, and medications were stored in original containers. Food Service: The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Kitchen areas are kept clean and free from litter, rodents, and insects. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts monthly disaster drills. The fire extinguishers were charged and last inspected 01/13/2025. Emergency exits and telephone numbers were posted. The facility has a sprinkler system. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does not currently have residents with oxygen. There are no residents on hospice or home health services at this time. The facility gates are self-closing and self-latching. The backyard is completely fenced. The facility has exiting door alarms, which were working on LPA's visit. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Apr 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst's (LPA's) De Leon and Rankin arrived at 10:00am to conducted a 1 year annual visit to the facility above. LPA met Administrator Juanito Pasion and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility Infection Control Plan on file. The facility has a sign in and out clipboard for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have tight fitting covers. Physical Plant & Environment Safety: The facility is a 5 bedroom and 2 bathroom, with 1 bedroom and 1 bathroom dedicated to staff. The facility is occupying 4 residents and employs 5 staff of which one is the Administrator and two are live in staff. The facility is clean, safe and sanitary. LPA's was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. Carbon Monoxide was tested and working properly. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage cabinets. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard for client use with furniture and plenty of shade. The facility has telephone and internet service for resident use. The backyard has a locked shed to store extra furniture and items. Continued 809-C Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 01/30/2025. The facility is approved for a capacity of 4 Non- Ambulatory of which 2 may be bedridden. Staffing: The facility employes 4 staff and 1 Administrator. Staff records are kept confidential. LPA reviewed 5 random staff files. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and a pending Administrator Certificate. All files were kept up to date with all requirements being met. Personnel Records & Training: The facility keeps confidential files. LPA reviewed 5 staff training records for Annual Training Requirements of 20 plus hours meeting 8 hours of dementia training, 4 hours of hospice care, postural supports and restricted health condition and 8 hours of other training to include ADL's, resident characteristics, emergency preparedness policy and procedures, infection control requirements, PPE and Quarterly Disaster Drills. Staff handling medications had required medication training. Trainer met the requirements to train staff. Initial training was kept on file. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Four files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Pre-Admission appraisals are conducted on perspective residents before accepting them into care. The facility does handle cash resources for one resident in care. LPA audited cash resources with ledger, receipts and cash which balanced. Facility does submit incident reports to the department when required. Incidental Medical & Dental: The facility has a medication cabinets in the family room that is kept locked. Facility provides or assist in providing transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected medication cabinet for all prescription and PRN medications with Doctors orders. LPA reviewed all residents medications, No medications labels were altered, no expired medications, and medications were stored in original containers. Continued 809-C Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and last inspected 01/22/2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. The facility has a sprinkler system. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does not currently have residents with oxygen. The does not currently have any hospice residents in care. The facility has 1 resident currently on Home Health services. Home Health services records are kept on file. The facility gates are self-closing and self latching. The backyard is completely fenced. The facility has exiting door alarms, which were working on LPA's visit. LPA conducted interviews with 2 staff and 1 resident. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Apr 12, 2024