Routine inspection·February 27, 2025

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:32 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator. The Administrator arrived shortly after. LPA met with Administrator, Anna Lee and the reason for the visit was explained. Entrance interview. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. GARAGE/BACKYARD: The garage is maintained locked at all times. LPA observed an adequate amount of emergency food and water. There is a laundry area, with a washer and dryer. Laundry detergent was observed in a locked cabinet inside the home. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) is designated as a staff room. The staff room is kept locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are five (5) restrooms. Three (3) are designated as private resident restrooms and two (2) are designated as shared/ common resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface. Grab bars were observed in the bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured all resident restrooms and ranged between 108.6- 113.9 degrees Fahrenheit, all within the required range. Report Continued on LIC 809C... Report Continued from LIC 809... COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 12:00 p.m., hardwire combination of smoke / carbon monoxide detector and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 10/08/2024 . The LPA observed all required postings throughout the common space. The last emergency disaster drill took place on 12/02/2024 and are conducted quarterly with the next one scheduled in March . The facility had the second annual automatic sprinkler system checked and passed on 06/21/2024. Activities were observed in the common areas. The fireplace in the living room was adequately screened. Cleaning supplies and other chemicals are kept in a locked hallway closet adjacent to the entrance inaccessible to residents in care. KITCHEN: The LPA inspected the kitchen/food service area at 10:19 a.m. The kitchen faucet was measured for hot water temperature, and it measured 116.1 degrees Fahrenheit at 10:19 a.m. Knives and sharps were observed in a locked box that sits on the counter. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. RECORDS: Record review began at approx. 10:30 a.m . Resident Records were reviewed beginning at 10:33 a.m. four (4) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:07 a.m. six (6) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Infection Control / Emergency disaster planning: During today’s visit LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate. Report Continued on LIC 809C... Report Continued from LIC 809... MEDICATIONS: Medications review began at approximately 11:46 a.m. The medications are in a locked closet adjacent to the kitchen in the living room area. Medications for four (4) residents were reviewed. Medications reviewed were found to be self administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed. INTERVIEWS : Two (2) staff and Two (2) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. LPA obtained the following documents - Resident roster ; LIC 9020, Staff roster ; LIC 500, and copy of the current Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.