Routine inspection·May 12, 2023

Amended report on 05/16/23 to reflect the day, time, LPA and continuation page from 05/12/23 at 08:10 AM; Licensing Program Analyst (LPA) L. Holmes conducted an unannounced required annual inspection. LPA met with Janice Joseph, Administrator (ADM), and explained the purpose of the visit. LPA toured the facility with ADM who currently holds a certificate (#6025466740) that expired on 03/15/23; renewal paid and not yet received. The facility’s fire clearance was approved for six (6) non-ambulatory residents; all six (6) may be non-ambulatory and one (1) may be hospice. Upon arrival LPA observed two (2) staff attending to residents and the two (2) residents were dining. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of five (5) total bedrooms which two (2) are occupied by the residents. All outdoor and indoor passageways are free of obstruction. The body of water is enclosed. A comfortable temperature was maintained at 75 degrees Fahrenheit (F). LPA observed lighting in all rooms to be adequate for the comfort and safety of the residents. Hot water temperature in the shared residents bathroom was measured at 116.5 degrees (F). All toilets, hand washing, and bathing areas were safe, sanitary and in operating condition. Hand washing poster, paper towels, and soap observed at all hand washing stations. Linen and hygiene products were available for residents. PPE, sanitizer, and paper goods are sufficient. ...continued on LIC809C. ...continued from LIC809 Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was purchased on 05/20/22 and is full. Emergency Disaster Plan is updated. First aid kit was complete and emergency kits for each resident. Fire drills are conducted quarterly. Five (5) of five (5) Staff records were reviewed, and all staff have criminal record clearance. All three (3) residents records reviewed were current and complete. The following forms are to be updated and submitted to CCLD 05/30/23: -Resident roster -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610E Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) -Create emergency binder -Update staffs files with first aid/CPR certification -Update staffs annual training records No deficiencies cited during visit. Exit interview conducted and a copy of this report provided to ADM.