Routine inspection·May 3, 2022

Licensing Program Analyst (LPA) Michael Cava conducted an annual infection control inspection. LPA met with the administrator, Bozena "Bonnie" Kozbial and advised her of the visit. The current census is five (5). Facility license and sketch, rights of resident council, grievance/complaint procedures, emergency disaster plan, resident bill of rights, personal rights, and neighborhood complaint procedures visibly posted. Annual fees are current and administrator certificate expires 7/31/2022 which is current and valid. Bonnie stated she is in the process of renewing her certificate. A physical plant tour of the facility inside and outside was conducted with the Administrator. The following common areas: living, dining, kitchen, resident bedrooms, bathrooms, staff room and office, were inspected to ensure the facility was in compliance with Title 22 Regulations: Kitchen/Food Supply: Food service area had Licensing requirement of (7) day nonperishable, and (2) day perishable. Food was properly stored in a healthy manner. Snacks and beverages are available for clients. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas were clean and inaccessible to pests. Appliances were functional and clean. Chemicals, household supplies, and knives, and medication was locked and secured. Living/dining/family/staff area and office: All indoor passageways were free from obstruction; inside temperature was comfortable and set at 72 degrees, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (4) bedrooms; (2) are private and (2) are shared. All bedrooms were properly furnished and supplied with appropriate bedding and linens. Rooms observed to have bedspread, sheets, pillowcase, mattress pad, and blankets, which were all in good repair. There were sufficient linens observed and available. Bathrooms: There are (3); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured in resident’s bathroom at 113 degrees Fahrenheit. Surrounding Grounds: Smoke alarms and carbon monoxide detectors were tested and operating properly. Fire extinguisher is fully charged. The charge date is 5/18/21. Administrator stated the fire department will be out by mid May to inspect the facility and their fire extinguisher. First aid kit furnished and fully equipped. All exit doors have alarms; all were operating. There were no visible hazards, and passageways were free from obstruction. There is a covered patio in the backyard with appropriate seating for residents when sitting outside. There are exercise equipment for the residents to utilize. The swimming pool is gated with a five foot fence and is locked and secured all around. The front yard/driveway posed no immediate health and safety threat to the residents in care. There is fountain, but no water located at the front lawn. Pursuant to title 22, division 6, chapter 8, there were no deficiencies observed during the day's inspection. The administrator was advised and a copy of this report given.