Inspection Reports for Princess II Group Home
10009 Princess Cut St, Las Vegas, NV 89183, NV, 89183
Back to Facility ProfileDeficiencies per Year
16
12
8
4
0
Severe
High
Moderate
Low
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 3
Capacity: 5
Deficiencies: 3
Nov 6, 2024
Visit Reason
The inspection was conducted as an annual State Licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A but had several regulatory deficiencies including failure to ensure one employee completed the in-person CPR and first aid training component, failure to maintain a clean and well-maintained backyard, and failure to adopt a comprehensive infection control policy.
Severity Breakdown
Severity: 2: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 3 employees received the in-person component of CPR and first aid training as required. | Severity: 2 |
| Failed to ensure the backyard was clean and well-maintained, with multiple items and refuse present. | Severity: 2 |
| Failed to adopt a comprehensive infection control policy including guidelines from a nationally recognized infection control organization. | Severity: 2 |
Report Facts
Licensed beds: 5
Current census: 3
Cigarette butts: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cherry Daelto | Administrator | Administrator confirmed CPR training lacked in-person component and acknowledged backyard maintenance issues and infection control policy deficiencies. |
| Employee #3 | Administrator | Failed to complete in-person CPR and first aid training component as required. |
Inspection Report
Annual Inspection
Census: 4
Capacity: 5
Deficiencies: 2
Nov 8, 2023
Visit Reason
The inspection was conducted as an annual State Licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility was licensed for five Category I residents but was found to have two Category 2 residents admitted, which was not in compliance with the license. Additionally, the facility failed to ensure annual tuberculosis screening for one employee was completed as required.
Severity Breakdown
Severity: 2: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Facility failed to ensure Category 2 residents were not admitted or retained contrary to the licensed Category 1 status for 2 of 4 residents. | Severity: 2 |
| Facility failed to ensure annual tuberculosis screening was completed for 1 of 3 employees. | Severity: 2 |
Report Facts
Licensed beds: 5
Current census: 4
Residents with licensing category issues: 2
Employees reviewed: 4
Residents reviewed: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cherry Daelto | Administrator | Signed the report and mentioned as facility administrator monitoring corrective actions |
| Employee #1 | Owner/Director | Failed to have annual TB screening documented |
Inspection Report
Annual Inspection
Census: 5
Capacity: 5
Deficiencies: 0
Nov 16, 2022
Visit Reason
This inspection was conducted as an annual and infection control State Licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A with no deficiencies identified. No further action is necessary.
Inspection Report
Annual Inspection
Census: 4
Capacity: 5
Deficiencies: 1
Nov 22, 2021
Visit Reason
The inspection was conducted as an infection control and annual State Licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A and was provided guidance on compliance with nondiscrimination, privacy, and cultural competency regulations. A regulatory deficiency was identified related to failure to ensure annual tuberculin testing was completed for 2 of 4 residents.
Severity Breakdown
2: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to ensure annual tuberculin testing was completed for 2 of 4 residents (Resident #1 and Resident #2). | 2 |
Report Facts
Licensed beds: 5
Residents present: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cherry Daelto | Administrator | Signed as Laboratory Director's or Provider/Supplier Representative |
| Employee #1 | Confirmed lack of documentation of annual TB test for 2021 for Residents #1 and #2 |
Inspection Report
Routine
Census: 5
Capacity: 7
Deficiencies: 0
Nov 18, 2020
Visit Reason
The inspection was a COVID-19 focused infection control State Licensure survey conducted to assess compliance with infection control measures in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility was found to be compliant with no deficiencies identified. Observations and interviews confirmed adherence to COVID-19 screening, social distancing, PPE use, sanitation practices, and staff training. The facility had ordered N95 masks and was provided guidance on medical clearance and fit testing for caregivers.
Report Facts
Boxes of gloves: 7
Surgical masks: 280
Gowns: 5
Face shields: 5
Non-contact electronic thermometers: 2
28 ounce bottles of hand sanitizer: 2
One ounce bottles of hand sanitizer: 30
Inspection Report
Annual Inspection
Census: 3
Capacity: 5
Deficiencies: 4
Jul 2, 2019
Visit Reason
This inspection was conducted as a State Licensure annual survey of the facility in accordance with Nevada Administrative Code (NAC) Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A but had several deficiencies including failure to ensure annual tuberculosis testing for one employee, lack of documented background check clearance for one employee, environmental hazards and maintenance issues in the facility, and failure to complete annual activities of daily living assessments for two residents.
Severity Breakdown
2: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to ensure 1 of 3 employees met the requirements for annual tuberculosis (TB) testing. | 2 |
| Failure to ensure 1 of 3 employees met the background check requirements of Nevada Revised Statute (NRS) 449.124. | 2 |
| Facility failed to ensure the interior and exterior premises was maintained and free of hazards, including loose wood boards, cracked chairs, stained grout, scuffed walls, and a hole in the wall. | 2 |
| Failure to ensure an activities of daily living (ADL) assessment was completed annually for 2 of 3 residents. | 2 |
Report Facts
Deficiencies cited: 4
Facility licensed beds: 5
Resident census: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tess Cervas | Owner | Signed the report and involved in corrective actions. |
| Employee #1 | Administrator | Named in background check deficiency. |
| Employee #2 | Caregiver | Named in tuberculosis testing and painting/maintenance activities. |
| Employee #3 | Interviewed and acknowledged deficiencies and environmental hazards. |
Inspection Report
Complaint Investigation
Census: 3
Deficiencies: 0
May 21, 2019
Visit Reason
The inspection was conducted as a result of a complaint and State Licensure survey initiated at the facility on 05/21/19 in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The investigation reviewed medication administration records, interviewed residents and caregivers, and reviewed facility policies. No regulatory deficiencies were identified and the complaint allegations could not be substantiated.
Complaint Details
One complaint (#NV00056987) was investigated with allegations regarding medication administration record completion, medication administration as prescribed, and destruction of expired medication. None of the allegations were substantiated.
Report Facts
Resident census: 3
Sample size: 3
Complaint count: 1
Inspection Report
Re-Inspection
Census: 4
Capacity: 6
Deficiencies: 13
Dec 4, 2018
Visit Reason
This inspection was a State Licensure grading re-survey conducted on 12/4/2018 to verify compliance following a previous inspection.
Findings
The facility received a grade of A. Several deficiencies were identified related to activities for residents, medication administration, staffing schedules, personnel files, health and sanitation, and resident records. Most deficiencies were already corrected from the prior 7/18/2018 inspection, but the facility failed to ensure activities on the activity calendar were followed and residents were asked to participate in activities.
Severity Breakdown
E: 3
C: 4
F: 4
D: 2
Deficiencies (13)
| Description | Severity |
|---|---|
| Qualifications of Caregiver-Med Training not met as per NAC 449.196 | E |
| Staffing Schedule not maintained monthly with required details | C |
| Personnel File missing required health certificates | E |
| Personnel File missing current certification for first aid and CPR | E |
| Health and Sanitation hazards present, impeding free movement of residents | F |
| Facility premises not well maintained internally and externally | F |
| Inadequate supplies of food maintained in the facility | F |
| Service of Food substitutions not documented or posted properly | C |
| Activities for Residents not properly followed or residents not asked to participate | F |
| Monthly activity calendar not prepared correctly or kept on file as required | C |
| Medication administration procedures not fully compliant with NAC 449.2742 | D |
| Medication administration records (MAR) not properly maintained | F |
| Resident files not properly maintained, stored securely, or complete | D |
Report Facts
Licensed beds: 6
Residents present: 4
Severity 2 deficiencies: 1
Scope: 3
Inspection Report
Annual Inspection
Census: 3
Capacity: 6
Deficiencies: 12
Jul 18, 2018
Visit Reason
This inspection was conducted as an annual State Licensure survey of the residential facility for group beds for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of D with multiple deficiencies identified including failure to ensure caregiver medication training, incomplete staffing schedules, missing tuberculosis and CPR documentation, unsafe storage of tools and hazards, inadequate food supplies, undocumented menu substitutions, incomplete medication administration records, and unsecured resident files.
Severity Breakdown
Level 1: 3
Level 2: 8
Deficiencies (12)
| Description | Severity |
|---|---|
| Failed to ensure 1 of 3 employees completed the initial 16-hour medication management training. | Level 2 |
| Failed to post a staffing schedule that included the current month and assigned shift. | Level 1 |
| Failed to ensure 1 of 3 employees met tuberculosis requirements with missing annual signs and symptoms check documentation. | Level 2 |
| Failed to ensure 1 of 3 employees were trained in first aid and CPR; training was expired. | Level 2 |
| Failed to ensure proper storage of tools and other items constituting danger to residents. | Level 2 |
| Failed to ensure premises interior and exterior were clean and well maintained, including decaying holes in patio roof. | Level 2 |
| Failed to ensure at least a 2-day supply of fresh food was available in the facility. | Level 2 |
| Failed to ensure menu substitutions were documented, kept on file, and posted in a conspicuous place during meal service. | Level 1 |
| Failed to ensure an activity calendar was prepared a month in advance. | Level 1 |
| Failed to ensure physician ordered medication was administered and documented for 1 of 1 sampled resident. | Level 2 |
| Failed to ensure medication had physician's order and matched medication administration record for 3 of 3 sampled residents. | Level 2 |
| Failed to secure resident files in a locked place; missing May and June MAR for 1 resident. | Level 2 |
Report Facts
Deficiencies cited: 11
Facility licensed capacity: 6
Resident census: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Marina Vaughn | Administrator | Named as the facility administrator and provider/supplier representative. |
| Employee #3 | Administrator | Failed to complete required 16-hour medication management training and tuberculosis documentation. |
| Employee #1 | Caregiver | Had expired first aid and CPR training. |
Inspection Report
Annual Inspection
Census: 2
Capacity: 7
Deficiencies: 0
Sep 13, 2016
Visit Reason
This Statement of Deficiencies was generated as a result of an annual State Licensure survey conducted in the facility on 9/13/16 by the Division of Public and Behavioral Health.
Findings
The facility received a grade of A with no regulatory deficiencies identified at the time of the survey.
Inspection Report
Annual Inspection
Census: 4
Capacity: 7
Deficiencies: 2
Oct 19, 2015
Visit Reason
The inspection was conducted as an annual State Licensure survey to assess compliance with regulations for a residential facility for low income elderly and disabled persons.
Findings
The facility received a grade of A. Deficiencies were identified related to tuberculosis testing for residents and violation of the low income rate agreement for one resident.
Severity Breakdown
Severity: 2: 1
Severity: 1: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to ensure 2 of 4 residents met tuberculosis (TB) testing requirements. | Severity: 2 |
| Violation of license agreement by having 1 of 7 low income beds occupied by a resident who did not qualify as low income. | Severity: 1 |
Report Facts
Residents reviewed: 4
Employee files reviewed: 3
Licensed capacity: 7
Census: 4
Low income beds: 7
Resident rate: 1800
Low income rate limit: 1000
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #2 | Acknowledged missing TB documentation and rate overage for low income beds |
Inspection Report
Annual Inspection
Census: 4
Capacity: 7
Deficiencies: 2
Oct 19, 2015
Visit Reason
This inspection was conducted as an annual State Licensure survey to assess compliance with state regulations for the Princess 2 Group Home.
Findings
The facility received a grade of A but had deficiencies including failure to ensure tuberculosis testing compliance for 2 of 4 residents and a violation of the low income rate agreement for 1 of 7 beds.
Severity Breakdown
2: 1
1: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to ensure 2 of 4 residents met tuberculosis testing requirements, including missing annual and second step TB tests. | 2 |
| Violation of low income rate agreement by having 1 of 7 beds occupied by a resident paying above the allowed rate. | 1 |
Report Facts
Licensed beds: 7
Current census: 4
Monthly rate: 1800
Low income rate fee: 35
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Employee #2 acknowledged missing TB documentation and rate violation |
Inspection Report
Annual Inspection
Census: 5
Capacity: 7
Deficiencies: 4
Oct 28, 2014
Visit Reason
The inspection was an annual State Licensure survey conducted to assess compliance with regulations for a residential facility for elderly and disabled persons.
Findings
The facility received a grade of A but had several deficiencies including failure to ensure a working fire extinguisher and functioning fire alarm, unsecured medication storage, unlocked resident files, and incomplete tuberculosis testing documentation for one resident. Some deficiencies were repeats from the prior year's survey.
Severity Breakdown
Severity: 2: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Failure to ensure a working fire extinguisher on the premises and a functioning fire alarm system. | — |
| Medication storage not secure; medications were observed unsecured on a cabinet shelf. | Severity: 2 |
| Resident files were not always secured; files were removed from an unlocked file cabinet. | Severity: 2 |
| Failure to ensure one resident met tuberculosis testing requirements. | Severity: 2 |
Report Facts
Census: 5
Total capacity: 7
Severity 2 deficiencies: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Luz A. Aguirre | Administrator | Signed the report and noted in handwritten comments regarding deficiencies and corrections |
Inspection Report
Annual Inspection
Census: 5
Capacity: 7
Deficiencies: 4
Oct 28, 2014
Visit Reason
This annual State Licensure survey was conducted to assess compliance with state regulations for the Princess 2 Group Home, a residential facility for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of A but had several deficiencies including lack of a working fire extinguisher and fire alarm issues, unsecured medications, unlocked resident files, and incomplete tuberculosis testing documentation for one resident. Some deficiencies were repeat findings from the previous year's survey.
Severity Breakdown
Severity: 2: 3
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure a working fire extinguisher was on the premises and the fire alarm system was functioning properly. | — |
| Failed to ensure medications were stored securely; medications were found unsecured on a cabinet shelf. | Severity: 2 |
| Failed to ensure resident files were locked; files were removed from an unlocked file cabinet. | Severity: 2 |
| Failed to ensure one resident met tuberculosis testing requirements as per NAC 441A.375. | Severity: 2 |
Report Facts
Deficiencies cited: 4
Resident files reviewed: 5
Employee files reviewed: 3
Facility licensed capacity: 7
Facility census: 5
Inspection Report
Annual Inspection
Census: 5
Capacity: 7
Deficiencies: 3
Oct 16, 2013
Visit Reason
The inspection was a State Licensure annual grading survey conducted to evaluate compliance with licensing requirements for a residential facility for elderly and disabled persons.
Findings
The facility received a grade of A but had deficiencies related to tuberculosis testing compliance for employees and residents, and fire extinguisher inspection. Deficiencies were identified with severity level 2 and scope 1 or 2.
Severity Breakdown
Severity: 2: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Failure to ensure 2 of 3 employees complied with tuberculosis testing requirements (TB tests done late). | Severity: 2 |
| Failure to ensure fire extinguisher was inspected annually (last inspected 1/5/12). | — |
| Failure to ensure 2 of 5 residents complied with tuberculosis testing requirements (missing initial two-step TB test). | Severity: 2 |
Report Facts
Number of residents present: 5
Total licensed capacity: 7
Number of employees reviewed: 3
Number of resident files reviewed: 5
Inspection Report
Annual Inspection
Census: 5
Capacity: 7
Deficiencies: 3
Oct 16, 2013
Visit Reason
The inspection was conducted as a State Licensure annual grading survey to assess compliance with regulatory requirements for the facility.
Findings
The facility received a grade of A but had deficiencies related to tuberculosis testing compliance for employees and residents, failure to ensure annual fire extinguisher inspection, and maintenance of resident files. Specific deficiencies included late TB testing for employees, missing initial two-step TB test for a resident, and an outdated fire extinguisher inspection.
Severity Breakdown
Severity: 2: 2
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to ensure 2 of 3 employees complied with tuberculosis testing requirements; annual 2013 TB test was late. | Severity: 2 |
| Failed to ensure fire extinguisher was inspected annually; last inspection was on 1/5/12. | — |
| Failed to ensure 2 of 5 residents complied with tuberculosis testing; Resident #5 missing initial two-step TB test. | Severity: 2 |
Report Facts
Licensed capacity: 7
Census: 5
Employees reviewed: 3
Residents reviewed: 5
Inspection Report
Capacity: 7
Deficiencies: 0
Oct 4, 2012
Visit Reason
This Statement of Deficiencies was generated as a result of a self-attestation questionnaire completed by the facility in lieu of a 2012 annual survey.
Findings
The questionnaire indicated the facility was in regulatory compliance and will receive the grade of A. No major regulatory deficiencies were revealed and no further action is necessary.
Inspection Report
Annual Inspection
Census: 6
Capacity: 7
Deficiencies: 2
Sep 21, 2011
Visit Reason
This document is a Statement of Deficiencies generated as a result of an annual State Licensure survey conducted at the facility on 09/21/2011.
Findings
The facility received a grade of A. Two deficiencies were identified: failure to prepare a comprehensive medication plan including all required components, and failure to ensure tuberculosis testing compliance for residents.
Severity Breakdown
Level 1: 1
Level 2: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to prepare a medication plan that included all eight required components. | Level 1 |
| Failure to ensure tuberculosis testing compliance for one resident. | Level 2 |
Report Facts
Licensed beds: 7
Residents present: 6
Deficiency severity Level 1: 1
Deficiency severity Level 2: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Luz B. Aquino | Administrator | Signed as Laboratory Director or Provider/Supplier Representative on the report |
Inspection Report
Annual Inspection
Census: 6
Capacity: 7
Deficiencies: 2
Sep 21, 2011
Visit Reason
This document is a result of an annual State Licensure survey conducted at the Princess 2 Group Home on 9/21/2011 to assess compliance with state regulations for residential facilities.
Findings
The facility received a grade of A but had deficiencies including failure to prepare a comprehensive medication plan covering all required components and failure to ensure tuberculosis testing compliance for one resident.
Severity Breakdown
Severity: 1: 1
Severity: 2: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to prepare a medication plan that included all eight required components. | Severity: 1 |
| Failure to maintain a resident file with evidence of tuberculosis testing compliance for one resident (Resident #6 missing second TB step). | Severity: 2 |
Report Facts
Resident files reviewed: 6
Employee files reviewed: 3
Facility licensed capacity: 7
Current census: 6
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