Post-licensing visit·October 23, 2024

On 10/23/2024 1:50PM, Licensing Program Analyst (LPA) T.Syess-Gibson conducted an unannounced Post Licensing inspection and met with Administrators (ADMs). LPA explained the purpose of the visit with ADMs. Administrator 1, holds a current certificate (#7035384740), which expires on 10/04/2025. Administrator 2, holds a current certificate (#6037285740), which expires on 10/04/2025. LPA observed one male resident with his wife in the living room watching TV and another male in his room watching TV. At 2:10PM, LPA inspected including, but not limited to, living room, kitchen, dining area, bathrooms, bedrooms, laundry area, activity room and outside areas. There were no bodies of water present at the facility. The facility has ten (10) bedrooms and four (4) bathrooms. Three bedrooms and one bathroom is designated for staff use only. Ample supply of toiletries and linens are available. Sufficient lighting and furniture throughout facility. 2 day perishable and 7 day non perishable food supply are available. Facility's inside temperature is maintained at 72 degrees, F. At 2:26PM, LPA observed Hot water temperature in resident's bathroom was measured at 111.7 degrees, F. Medications, toxins and sharps observed stored locked and inaccessible to residents in care. Fire extinguisher, smoke and carbon monoxide detectors were observed operational. Emergency Disaster Plan dated 09/25/2024 was near required posters and were centrally posted. Exits and passageways are free of obstruction. Disaster drills are conducted every three months. Continued on next page, LIC809-C Continue from LIC809 At 2:41 PM LPA reviewed two (2) residents and four (4) staff files, medication and medication logs. Staff were fingerprint cleared and associated to facility. Resident file contain Admission agreement, Pre-placement appraisal, ID/Emergency information, Personal Rights, Physician's report, Safeguard of property & valuables. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/25/2024: · LIC 500- Personnel Report · LIC 308- Designation of Facility Responsibility · LIC 610E- Emergency/Disaster Plan (9 pages) · Evidence of Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided to Jamie Ruiz.