Routine inspection·January 22, 2025

On 01/22/25 at 11:45AM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. ADM has current administrator certificate# 6070821740 which expires on 06/11/26. At 12PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 72 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. LPA reviewed 4 staff and 5 resident files. Continued on next page, LIC 809-C At 12:35PM, LPA reviewed 3 staff and 4 resident files. Staff had criminal record clearances to work and are associated to the facility. Residents records contain Admission Agreements, Physicians' reports, Consent forms, Needs & Services Plans/Appraisals, Personal Rights and Safeguard of Property & Valuables. The facility serves residents with Dementia. The facility has potentially dangerous objects locked and inaccessible to residents in care. The facility has auditory signals on each sliding exit door. Staff at the facility has the required Dementia training. During visit, LPA observed the following deficiencies: Hot water temperature measured at 127.3 deg F Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Exit interview conducted and, appeal rights and a copy of this report provided .