Peninsula Elderly Care Home-laurel Llc

On November 6, 2024, Licensing Program Analyst (LPA) John Calandra arrived at the facility at 8:30 AM to conducted an unannounced follow up Case Management visit. Purpose of visit is due to a self reported incident that was reported on 10/26/2024. LPA Calandra was greeted by Evelyn Tabago, Caretaker and explained the purpose of the visit. Jennifer Tobias, Administrator arrived later during the visit. On October 26, 2024, the Department received a report from the facility stating that R1 had slapped and spit on S1. Per interview with the Administrator, Jennifer Tobias, R1 went to see R1's Neurologist recently and new medications have been prescribed but not started yet. During the visit, LPA reviewed R1's LIC 602 and Care Plan and obtained electronic copies of both documents. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left at the facility.

On November 6, 2024, Licensing Program Analyst (LPA) John Calandra arrived at the facility at 8:40 AM to conducted an unannounced Case Management visit. Purpose of visit is due to a self reported incident that was reported on 10/26/2024. LPA met with Administrator, Jennifer Tobias and explained the purpose of the visit. Neeru Verma, Head of Operations arrived later during the visit. The incident occurring on 10/26/2024, involved a resident (R1) striking and spitting on a staff member, S1. The incident was reported to CCLD and confirmed based on the incident report and interview with Administrator, Jennifer Tobias. During the visit, LPA Calandra interviewed 4 residents, staff, and Administrator. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left at the facility.

On July 18, 2024, Licensing Program Analysts(LPAs) John Calandra and Yi "Sam" Jian, arrived at the facility at 8:39 AM to complete the annual 1-year required unnanounced Annual Inspection. LPAs Calandra and Jian were greeted by Alma Tamonte, Caregiver and explained the purpose of their visit. Administrator, Jennifer Tobias arrived later during the visit. LPAs Calandra and Jian reviewed 4 staff files. All were observed to be complete. LPAs Calandra and Jian interviewed 2 residents and 3 staff. A Technical Violation was provided for not having a internet accessing device present that allows a resident to access it for discussion of personal or confidential information with a reasonable level of personal privacy. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left at the facility.

On June 19, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 1:56 PM, to complete the Annual 1-year required inspection. LPA Calandra was greeted by Evelyn Tabajo, Caregiver and explained the purpose of the visit. Administrator, Jennifer Tobias arrived later during the visit. LPA Calandra toured the physical plant. This is a 1-story building with 7 bedrooms, 5 bathrooms, a front yard and backyard, living room, dining room, kitchen, 2 storage spaces, and staff quarters in the garage. The facility's Fire Extinguisher was observed to be fully charged and last inspected on April 4, 2024. The facility's Fire Alarms and Carbon Monoxide detectors were observed to be in working order. All bedrooms had the required furniture and sufficient lighting. There were no accessible bodies of water or hazards observed. The facility's First Aid had the required items. Hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility was maintained at a comfortable temperature of 75 degrees Fahrenheit. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. LPA Calandra reviewed 5 resident files. All were observed to be complete. All Sharp objects, disinfectants, and cleaning supplies were observed to be locked and in-accessible to persons in care. LPA Calandra also reviewed Centrally Stored Medication Records. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. No deficiencies were cited during today's visit. The Annual will be completed on a later date. An exit interview was conducted. This report was reviewed with Jennifer Tobias, Administrator and a copy of the report left at the facility.

On February 13, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Administrator, Jennifer Tobias and Licensee, Neeru Verma and explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageways were free of obstruction. No accessible bodies of water of fire safety hazards observed. Extra linen was observed. LPA toured seven private resident bedrooms and five bathrooms; two full and three half baths. All resident rooms were observed with all required furniture. Bathrooms were observed clean and odor-free; equipped with liquid soap and paper towels. Living room and dining room was observed to be free from tripping hazards. A comfortable temperature is maintained and lighting is sufficient for comfort. Hot water throughout the facility measured between 114.6-118.9 degrees F throughout the facility. Sharps, toxins and medication were locked and inaccessible to residents. Carbon monoxide monitors are working properly. All fire extinguishers have been checked and current as of April 2023. LPA observed 2 days for perishables and 7 days non-perishables. Emergency drills are logged and done every three months. During the visit, ants were observed on the floor near the dining room table. According to the Licensee, they have pest control come every month to treat the ants and pests. Invoice provided to LPA shows pest control came on 2/5/2024 and treated the home. Licensee called pest control during the visit; pest control will be back to the facility tomorrow to inspect the facility again. LPA reviewed 5 resident records and 4 staff records. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No citations are issued during the visit. LPA reviewed report with Licensee and Administrator and a copy is provided.

On June 11, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. LPA met with Caregiver, Evelyn Tabago, and Administrator, Jennifer Tobias joined shortly thereafter. LPA explained the purpose of the visit. Upon arrival, LPA observed the COVID-19 posting on the front door, however advised Caregiver to post more COVID reminder signage. LPA was screened at entry point and caregiver was able to provide LPA with screening log documentation for staff, residents, and visitors. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. This is a single story facility with 7 bedrooms; all private rooms and 5 bathrooms; 2 full and 3 half baths. Infection control practices are present: entry procedures, face coverings, daily monitoring for residents and staff, COVID-19 signage posted throughout the facility, and 30-day PPE supply. LPA observed bathrooms to be equipped with hand-washing signs, liquid soap, and paper towels. LPA advised caregiver to ensure communal bathrooms have a trash can with a fitted lid and the remove hand/bath towels from the bathrooms. LPA observed medications and toxins locked and inaccessible to residents. LPA toured the kitchen and observed 2 day perishable and 7 day non-perishable present. LPA observed sharps drawer to be unlocked and accessible to residents, however according to the administrator, the kitchen door is locked at all times unless staff is in the kitchen. A comfortable temperature is maintained and lighting is sufficient for comfort. Extra linen was observed to be present. Washer and dryer was observed to be in good working condition. (CONT. TO 809C) 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 LPA requested for the following to be submitted to CCLD by 7/18/2022: LIC309 Administrative Organization LIC308 Administrative Responsibility LIC500 Personnel Report LIC610E Emergency Disaster Plan Administrator Certificate This report is reviewed and discussed with Administrator, Jennifer Tobias; a copy is provided.

Licensing Program Analyst (LPA) Gladys Kuizon conducted an annual inspection today and met with Administrator Jennifer Tobias. At 1:05 PM, LPA entered the facility through the facility's central entry point and was screened by staff. At 1:10 PM, a tour of the facility was conducted. COVID-19 postings were observed. Staff were observed wearing face coverings. 5 residents and 2 staff were present during inspection. The facility has at least 30 days' supply of personal protective equipment (PPE) including. Hand sanitizers, soap, and paper supplies were observed available. Hand-washing guides were posted by hand-washing stations. At least 2 days' supply of perishable foods and at least 1 week's supply of non-perishable foods are available in the premises. Storage sheds were inspected in the backyard. Exit routes were observed clear and unobstructed. No bodies of water were observed. According to Administrator, the facility has achieved 100% vaccination rate against COVID-19 for both residents and staff. The facility is currently accepting visitors inside the facility. The facility's mitigation plan was received and reviewed by Community Care Licensing. No deficiencies were cited. Exit interview conducted with Administrator and a copy of this report was provided during visit.