Routine inspection·March 5, 2025

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:45 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Administrator, Kemi Oluwole arrived shortly after 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. INTERVIEWS : From 9:55 a.m. – 10:38 a.m. two (2) staff and one (1) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. KITCHEN: The LPA inspected the kitchen/food service area at 10:50 a.m. Knives and sharps were observed in a locked drawer. 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. The kitchen faucet was measured for hot water temperature, and it measured 110.1 degrees Fahrenheit at 10:52 a.m. Cleaning supplies and other chemicals are kept in a locked closet / cabinet inaccessible to residents in care. LPA observed an adequate amount of emergency food. BEDROOMS: There are eight (8) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and two (2) staff rooms. The staff rooms are kept locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Report Continued on LIC 809C... Report Continued from LIC 809C... RESTROOMS: There are three (3) restrooms. Two (2) are designated as shared / common restrooms and one (1) is designated as a staff restroom. Resident restrooms were observed to be equipped with a slip resistant surface. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured all resident restrooms and ranged between 110.6-116.1 degrees Fahrenheit, all within the required range. 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 11:17 a.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 02/17/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 12/01/2024 and are conducted quarterly with the next one scheduled in March. The facility had the annual automatic sprinkler system checked and passed on 09/30/2024. Activities were observed in the common areas. The fireplace in the living room was adequately screened. LPA observed a locked storage closet adjacent to the entrance with an adequate amount of incontinent supplies, PPE, and emergency water. LPA observed a deep freezer that was checked for proper labels and expiration dates. There is a functioning telephone on the premises. Adjacent to the dining room is an open office where locked files and locked medication cart is located. BACKYARD: The entire property is fenced. There is a laundry area, with a washer and dryer. Laundry detergent was observed in a locked cabinet. The backyard has a portable umbrella for shade with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. There is a locked storage shed in the back yard inaccessible to residents. Infection Control / Emergency disaster planning: At 11:08 a.m. 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 809C... RECORDS: Record review began at approx. 11:08 am . Resident Records were reviewed beginning at 11:13 a.m. and Personnel Records at 12:43 p.m. Five (5) 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. Four (4) 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. MEDICATIONS: Medications review began at approximately 2:08 p.m. The medications are in a locked medication cart adjacent to the kitchen. Medications for four (4) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed. LPA obtained the following documents - Resident roster - LIC 9020, Staff roster - LIC 500, a copy of the Limited Liability insurance, and an updated facility sketch. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of the report provided.