The Park Grove

Type of visit: Required - 1 Year

At 10:50am, on 12/30/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrators Sisenando Marcos and Susan Claire Marcos, announced who he was and the reason for the visit. Administrators and LPA conducted a full tour of the facility. This facility is a single story residential home with six resident single occupancy bedrooms. One resident bedroom has a private en suite bathroom, two bedrooms share a "jack and jill" bathroom, and there is one full shared bathroom. There is a living room, dining area, kitchen and office area. A staff bedroom is located off the kitchen and a staff only full bathroom next to the living room. There is a garage with access to laundry machines, hazardous items are locked in cabinets for resident safety. LPA noted that the backyard has ample space and the front yard has seating and shade for residents and visitors. LPA noted fresh fruit and snacks in the kitchen for residents to enjoy. The facility has battery operated smoke detectors in each room that are all working, the carbon monoxide detectors are in the hallways and functioning normally. LPA observed a fire extinguisher in the hsllway that was tagged current and in the green compression range, serviced on 1/13/2025. The facility sprinkler system was tested on 1/10/2025 by Mid-Coast Fire Protection. LPA tested facility hot water at 105*(f), within regulation temperatures 105*-120* (f). LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. LPA noted that the facility is clean and in good repair. Medications, Staff and resident files are locked in the office area. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review. LPA and Administrators conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the Administrators.the state’s words, verbatim · CDSS document, Dec 30, 2025

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 9:00am on 11/20/2024, Licensing Program Analyst (LPA) De Leon conducted an unannounced annual visit. LPA met with Licensee/Administrator's Sisenando Marcos 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 has a current Infection Control Plan. The facility has a sign in and out clipboard for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, and hand soap. 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). Operational Requirements: The facility has a current plan of operation with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 01/01/2025. The facility is approved for a capacity of 6 with 6 Non-Ambulatory of which 6 may be bedridden. Hospice approved for 4. Physical Plant & Environment Safety: The facility is a 8 bedroom, 6 bedrooms for resident use. The facility has 4 bathrooms currently occupying 3 residents and 2 full time live in Administrators. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. 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, locked in laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has an fenced backyard for client use with plenty of shade. The gates on the sides of house are self closing and self latching. The facility has telephone and internet service for resident use. Continued 809-C Staffing: The facility employes 2 full time live in Administrators. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. Administrator Certificate expires 11/03/2025. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have training to met topics to cover for 2024. Residents Rights and Information: All required personal rights are posted. CCL and LTCO Complaint posters are posted. The facility has a posting board on the wall in the entry with all required postings posted. The facility offers telephone and internet service to residents in care. Planned Activities: The facility has a cupboard with puzzles, games, books and TV in rooms and living rooms, Residents walk around pathways in the back yard. There is enough space inside and outside for activities. The residents do what they want and what they like to do. 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 staff are observed for personal hygiene and food sanitation practices. Incidental Medical and Dental Services: Facility provides or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA checked medications for all residents, no medications was expired, medication labels were not altered and medications were stored in original containers. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 3 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and completed in separate confidential binder for each resident in care. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and last inspected on 09/10/2024. 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. 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 has no resident currently on oxygen. The facility does not have any residents on Hospice in care. The facility does not have any residents receiving Home Health services. The facility does not have delayed egress. Exit doors have alarms. LPA interviewed 2 staff and 1 residents. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Nov 20, 2024

Type of visit: Required - 1 Year

At 9:05am on 12/19/2023, Licensing Program Analyst(LPA) Jeffries arrived unannounced to the facility to conduct the annual facility inspection. LPA met with Administrator's Sisenando and Susan Marcos announced who he is and the reason for the visit. LPA conducted a full facility tour. LPA noted that this is a 8 bedroom and 4 bathroom There are 6 resident rooms and two staff rooms. Three of the 4 bathrooms are resident bathrooms and one bathroom is designated for staff. LPA observed at least two days of perishable and at least seven days of non perishable foods on hand in the facility, There is emergency water and food stored in the garage. This facility has a full use generator on the property. LPA noted that there are smoke detectors located throughout the facility that are hardwired and functional, LPA noted that the carbon monoxide detector is located in the hallway and is functioning properly. LPA noted the two fire extinguishers on hand are currently tagged and in the green. The facility has a fire sprinkler system that was pressure certified on 01/10/2023 by Mid-Coast Fire Protection and will be reinspected in January of 2024. LPA noted that all rooms had exit doors and all passageways and doors were free and clear of obstructions. LPA noted that the facility is clean and in good repair. LPA conducted a sample medication audit and reviewed the centrally stored medication record (CSMR). LPA reviewed staff and resident files. LPA noted that resident rooms have proper lighting storage and linins. LPA noted that the water temperature in the facility is within regulation parameters of 105*-120*(f). LPA noted that during the full inspection of the facility and facility grounds there were not violations or citations. Administrators and LPA conducted a full review of the annual care tools modules. LPA noted that there were no technical, violations, or citations issued as a result of the full care tools review. LPA noted that there are no citations issued as a result the this annual inspection. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Dec 19, 2023