Routine inspection·October 31, 2023

On 10/31/2023 at 12:00 PM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. LPA met with Administrator, Paul Lam and explained the purpose of the visit. The facility’s fire clearance was approved for 6 Non-Ambulatory which 1 may be Bedridden. LPA toured facility with Paul including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 is occupied by the staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathrooms were measured within range 105-120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 08/16/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 10/01/2023. Report continues on 809 C At 12:30 PM, LPA reviewed 6 of 6 residents records. At 1:10 PM, LPA reviewed 4 of 10 staff records and 4 of 4 have current first aid training and associated to the facility. At 12:12 PM, LPA reviewed a sample of 1 of 6 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/07/2023: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.