Routine inspection·November 1, 2024

On 11/01/2024 around 12:00 PM, Licensing Program Analyst (LPA) L Holmes arrived unannounced to conduct a required 1-year Annual Inspection. LPA was greeted by one Care Staff and Elisa Empig, Administrator (ADM), and explained the purpose of the visit. Standard Certificate #6001609740 Exp: 12/28/2024. LPA and ADM toured the facility including but not limited to the common areas, dining room, bathrooms, kitchen, bedrooms and garage. The facility consists six (6) residents. The residents were dining and engaged in activities. Outdoor and indoor passageways were free of obstruction. There were not any bodies of water present. A comfortable temperature was maintained at 71 degrees Fahrenheit (F). LPA observed lighting in all areas to be adequate for the comfort and safety of the residents. The hot water temperature in the shared restroom was measured at 116.2 degrees (F). The shared restrooms had paper towels, soap and garbage cans; all areas were safe and sanitary. PPE, sanitizer, and paper goods remain sufficient. There is a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. Smoke/carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed full and serviced 06/26/24. Emergency Disaster Plan is updated. Safety drills are rotational and last performed on 09/24/24. LPA reviewed four (4) staff files, and six (6) resident files. The following forms are to be updated and submitted to CCLD: -LIC500 Personnel Report & Resident Roster -LIC308 Designation of Administrative Responsibility (Reviewed) -LIC610E Emergency Disaster Plan (Reviewed) -An updated copy of Administrator Certificate(s) (Reviewed) -Liability Insurance (Reviewed) Exit interview conducted and a copy of this report provided to Elisa Empig, Administrator (ADM)