Hailey's Care Home

On 7/17/25 at 1:00 PM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Maria Riformo and explained the purpose of the visit. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the kitchen was measured at 115.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Fire extinguisher, smoke detectors and carbon monoxide detectors were in operating condition during visit. Emergency Disaster Plan was last reviewed on 1/20/25. First aid kit was observed to be complete. LPA reviewed 2 residents records and 2 staff records; all were complete. LPA also reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided

On 07/08/2024 around 11:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct Proof of Correction (POC) visit. LPA met with Caregiver Maria Del Rosario who telephoned Licensee/Administrator (ADM), Maria Riformo and explained the purpose of the visit. ADM arrived at the facility shortly after. On 07/02/2024 Administrator emailed LPA stating, “I have received all the records. To comply with the regulations, I’ll send you all the corrections on the due date”. Facility has the following deficiencies that was not cleared resulting in civil penalties: · HSC 1569.618(c)(3) - 3 days x $100 = $300.00 · HSC 1569.311 - 3 days x $100 = $300.00 ADM replaced Fire Extiinguisher that was observed full and carbon monoxide unit was in working condition. Civil Penalties in the total amount of $600.00 are assessed 07/08/2024 for failure to meet POC date for all deficiencies cited above. Facility is subject to ongoing daily civil penalties until deficiencies are corrected. Exit interview conducted. A copy of this report, appeal rights provided and LIC421FC provided.

On 07/27/23 around 01:10 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required annual inspection. LPA contacted Maria Riformo (ADM) and explained the purpose of the visit. Matthew Riformo, Administrator (ADM) arrived about 10 minutes later to assist with the inspection. ADM currently holds a standard certificate (#6045022740 ). The facility’s fire clearance was approved for six (6), no more than four (4) non-ambulatory residents and one (1) bedridden. Upon entry, LPA and ADM toured the facility including, but not limited to common areas, bathroom, bedrooms, kitchen, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. The facility has an updated Infection Control Plan (ICP). All hand washing stations were equipped with soap, paper towels and covered garbage cans. There is a surplus of PPE centrally located inside the facility that is accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 106.5 degrees Fahrenheit (F) and the facility's temperature was comfortable. Fire extinguisher was observed full. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. continued on LIC809C... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ...continued from LIC809. LPA reviewed two (2) complete staff records. There are not any residents at this time. The following forms are to be updated and submitted to CCLD: -LIC500 Personnel Report (Reviewed) -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610E Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) Exit interview conducted and a copy of this report provided to ADM.

On 07/14/2022 at 3:20 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an annual Infection Control Inspection. LPA met with Licensee Maria Riformo and Administrator Matthew Riformo (ADM). LPA explained the purpose of the visit. Facility has a COVID-19 mitigation plan on file. LPA observed a screening station at the entry that contained a thermometer, hand sanitizer, masks, face shields, gowns, gloves, COVID-19 signage, and a visitor sign-in log. LPA toured the facility including, but not limited to common areas, bathroom, and kitchen. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. Licensee to post 20 seconds to hand washing sign in the bathroom, and create an isolation cart for infection control. There was a sufficient supply of non-perishable foods; there are not any residents at this time. All hand washing stations were equipped with soap, paper towels, and covered garbage cans . There is a surplus of PPE centrally stored inside the facility that is accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 109 degrees Fahrenheit (F). Fire extinguisher was observed full. Smoke/Carbon Monoxide detectors were observed operational and first aid kit complete. Licensee, Maria Riformo agreed to inspect, disinfect facility and notify, CCLD prior to accepting new residents. The following forms are to be kept updated and submitted to CCLD: -LIC500 Personnel Report (Reviewed) -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610E Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) (Reviewed) Exit interview conducted and a copy of this report provided to Licensee, Maria Riformo

On 05/12/22 at 09:25 AM, Licensing Program Analyst (LPA) L. Holmes conducted an announced case management visit to amend complaint ( 15-AS-20220328152756). LPA explained the purpose of the visit with Maria Riformo, Administrator (ADM), which is to capture signatures of LPA and ADM. LPA obtained signatures for the LIC9099-D and LIC9099-C Exit interview conducted and a copy of the amended report was given to the Administrator.