Immaculate Home at Withers

On 09/29/2023 at 11:25 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Administrator Norberto Geronimo and explained the purpose of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced 06/18/2023. At 12:25 pm LPA reviewed 6 residents records. At 11:52 am, LPA reviewed 5 staff records and 5 of 5 were fingerprint cleared and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 7/20/2022 starting at 9:45 a.m., Licensing Program Analyst (LPA) Catherine Lin arrived unannounced to conduct Infection Control Inspection. LPA met with staff Maricel Gorremans and disclosed the purpose of the visit. LPA spoke with Administrator Geronimo Norberto on the phone and he authorized staff to give tour and sign on the report. Upon entry, LPA’s temperature was checked by the staff and requested to wash hands before entering to facility. LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, bathrooms, kitchen, common areas, and outdoor areas. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility maintained PPE supplies at central location and easily accessible for staff. Facility has Mitigation Plan, Emergency Disaster Plan, and maintains record of routine screening for residents, staff, and visitors. No deficiency cited during visit. Exit interview conducted with staff/caregiver, and a copy of this report provided.

On 7/14/2021 at 10:30 AM, Licensing Program Analyst (LPA) Leslie Ibo conducted an infection control annual inspection and explained the purpose of the visit with S1 and S2. LPA spoke with administrator, at 11:15 AM , Administrator arrived at the facility and left at 1:00PM. Administrator gave authorization for S1 to sign the annual inspection reports. LPA observed 2 staff wearing face masks during visit. LPA observed 1 residents relaxing in the living room while the other 3 residents were resting in their bedrooms. Facility has a completed mitigation plan. LPA inspected the facility inside and outside. LPA observed a screening station located near the front entrance with visitor's log, hand sanitizer, gloves, face masks, no touch temperature probe. Routine symptom screening (+/-) temperature and symptom check) is done at entry for all staff, residents and visitors. LPA observed COVID-19 posters were posted in common areas to promote hand washing, cough/sneeze etiquette and physical distancing. Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. LPA observed furniture spaced six feet apart for social distancing among residents in the living room. Continued on next page LIC 809-C 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 Infection control designated leader is the Administrator. There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the garage. Facility room temperature was maintained at 72 degrees Fahrenheit. A certified administrator is on site a minimum of 20 hours a week to oversee proper business operation and compliance with COVID-19 infection control practices. Smoke and Carbon monoxide detectors were operational. No deficiencies were observed during the infection control annual inspection. Exit interview conducted and a copy of this report provided.