Psalm 23 Assisted Living II

Allegation investigated: Staff did not keep facility clean, safe, sanitary Staff did not provide appropriate variety of foods

Licensing Program Analyst (LPA), Natasha Persaud conducted a telephonic complaint investigation visit regarding the above mentioned allegations. LPA met with Licensee, Irma Laconsay. During the investigation, the facility was toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged that staff did not keep the facility clean, safe, and sanitary. It was reported that Resident #1’s (R1) belongings had chew marks from rodents. The licensee stated once it was reported they set traps. They caught 2 mice, but it was in the garage, none were observed in the facility. The licensee contacted a pest control company to inspect the facility and additional measures were implemented. An outside source reported they observed chew marks in R1’s belongings. On 05/11/26, LPA observed a large zip lock plastic bag containing R1’s belongings and the bag had some holes that appeared as bite marks in separate areas. R1 confirmed the rodent issue was resolved and there are no more rodents. In addition, it was reported the facility was unsanitary due to staff leaving soiled diapers unattended for hours in a garbage bag outside R1’s room. R1 confirmed observing bags with soiled diapers outside the facility, not inside. Continued on LIC 9099C. Unsubstantiated R1 also confirmed when they return from program the bags have already been disposed of. Staff stated they throw the soiled diapers in a garbage bag and once incontinent care is concluded, the bag is disposed of in the trash located in the backyard. Staff denied leaving soiled diapers unattended. Outside source interviews revealed that they have not witnessed garbage bags with soiled diapers unattended. It was also alleged that staff did not provide appropriate variety of foods. The facility has a menu posted on the fridge with a variety of food items. Resident interviews confirmed being provided a variety of food. Staff also confirmed they cook a variety of foods. On 05/11/26, LPA observed a variety of meats, vegetables, fruits, canned items, along with other food items. Staff reported R1 prefers Hispanic food, therefore, they prepare Hispanic foods for R1 and other meals for the other residents. On 05/11/26, LPA observed R1 being served a Hispanic dish called Menudo, along with rice and pudding for dessert. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Irma Laconsay whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, May 14, 2026 · control 08-AS-20260504151145

Allegation investigated: Staff did not provide incontinence supplies Satff did not provide the necessary food quantity to meet the resident needs Staff unable to communicate with resident due to language barrier

Licensing Program Analyst (LPA), Natasha Persaud conducted a telephonic complaint investigation regarding the above mentioned allegations. LPA met with Licensee, Irma Laconsay and discussed the investigation. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged staff did not provide incontinent supplies, It was reported Resident #1 (R1) had an incontinent accident last week due to not having a liner that goes inside their brief/diaper, and their clothes became soiled with urine. It was reported R1 was not receiving their wipes and liners at the facility. An outside source (OS) reported R1 had sufficient incontinence supplies but R1 didn’t like the type of briefs/diapers and or liners. However, the facility provided necessary incontinent supplies. In addition, the OS reported they bought the diapers/liners R1 preferred and the issue was resolved. On 03/23/26 and 05/11/26, R1’s incontinent supplies were observed at the facility and were sufficient. Also, incontinent supplies were observed with resident names written on the outside of the supplies to identify the correct resident with the correct product. Continued on LIC 9099C. Unsubstantiated Furthermore, R1 had additional incontinent supplies stored in their room. R1 stated their family member purchased the incorrect size and they were too big, causing it to leak. R1 confirmed they now have the correct size and the issue was resolved. Staff confirmed there are no issues with R1’s briefs/diapers, and/or liners and they have a sufficient supply. It was also reported that R1 was provided with very small portions of food. Outside sources were interviewed and reported not observing food being served at the facility. However, they have observed food being cooked. R1 stated they were served the quantity necessary at the facility but didn’t like the food. R1 eats breakfast and lunch at their day program and eats dinner at the facility. On 03/23/26, lunch was observed that consisted of four (4) crackers, bowl of soup and a bowl of Jello. On 05/11/26, LPA observed residents eating lunch, which consisted of fried chicken, mashed potatoes, and vegetables. LPA also observed the residents dinner, which was half of a sandwich, salad and pudding for dessert. The staff showed LPA they prepared a different meal option for R1, which was Menudo, rice, and pudding for dessert. The food portion served to residents was observed as the quantity necessary to meet the resident’s needs. The facility has a menu posted. However, staff reported it’s not followed often, as they provide variety to the residents. The licensee reported they reduced the portion size of the food due to waste. The residents were made aware they can have more if needed. However, they finish their plate and are content. Other residents interviews confirmed they received the food quantity necessary. Lastly, it was alleged staff were unable to communicate with residents due to language barrier. It was reported staff do not speak Spanish and there was a communication barrier with R1. OS reported R1 can understand enough English to communicate their basic needs. Upon admission to the facility, there was knowledge R1 was Spanish speaking, and it was determined there were no issues. Additional interviews confirmed staff have access to R1’s responsible party to interpret if needed. Further staff interviews confirmed the interpretation application was used by the licensee but not the staff due to R1 communicating their needs. R1 reported staff do not understand them. However, R1 confirmed the staff are meeting their needs and they were able to communicate their needs to staff. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee, Irma Laconsay whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, May 14, 2026 · control 08-AS-20260319113207

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility and conducted the visit with Staff, Marieta David. Licensee, Irma Laconsay and Staff, Jerry Laconsay were present. LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperature at taps accessible to residents were all compliant and measured at 105 F.. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, and/or fireplaces accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per the the administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed multiple staff and resident records/files. The reviewed files contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator, Irma Laconsay to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, May 11, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Natasha Persaud conducted an announced second Prelicensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 10/17/24. The facility was approved to care for six (6) Non-Ambulatory Elderly Residents. LPA was greeted and allowed entry into the facility by and met with Applicant, Irma Laconsay. Structure- The facility is a single story structure with 4 bedrooms and 2 bathrooms. No bodies of water were observed. Bedrooms Residents- Rooms #2-#4 may be used for Non-Ambulatory or bedridden. Approved one (1) bedridden; Room #1 approved for non-ambulatory only. Bedrooms Staff- There are no staff rooms. Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. Linens & Hygiene Supplies- Adequate supply. Emergency Phone Numbers, Exit Plan and Required Postings- Posted. Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired. Appliances- Stove burners, oven, microwave, washer, and dryer working. Toxins- Stored in a locked cabinet. Water Temperature- Measured at 106 degrees F. Medications- Centrally stored and locked in a cabinet. First-Aid Kit- Stored in a locked cabinet. Resident & Staff Files- Stored in locked cabinet. Activities- Adequate supplies board games, puzzles, and magazine's for resident's use. Fire clearance- Approved on 02/10/25. Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Prelicensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Applicant, Irma Laconsay whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Apr 23, 2025