Routine inspection·July 7, 2022

Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility at 1:37pm on 07/07/2022 to conduct a One (1) year Required Infection Control visit. LPA meet with Stella Ezros and explained the purpose of this visit. The facility has an approved mitigation plan on file. A tour of the physical plant was conducted at 1:55am and the following was observed: The facility has six (06) bedrooms and (06) bathrooms located in the bedrooms currently occupying (6) residents. The facility has one main entrance being used, there are required Covid-19 prevention signage (handwashing, coughing etiquette, and physical distancing) posted. The PPE screening station is located on a table at the entrance equipped with sufficient PPE readily accessible, a thermometer, hand sanitizer, gloves, mask, and sign in sheet at the time of visit. The facility maintains a temperature at 76 degrees Fahrenheit which is controlled by an application on the administrators cell phone. The facility has a fire clearance for (06) non-ambulatory. Kitchen: At 2:06pm LPA observed the kitchen to be clean and an adequate supply of perishables and non-perishable food. There is a pantry storing dry food, condiments, and can goods. Food was properly labeled and stored. All appliances observed to be operational and in good repair. Fire extinguisher observed to be under the kitchen sink with an inspection tag of March 2022. Sharps observed to be stored in the kitchen pantry inaccessible to resident in care. Contuinued on LIC809C Bedrooms: At 2:17pm LPA observed (6) bedrooms to be appropriately furnished with sufficient lighting. LPA observed appropriately bed linen and comforters on all beds. All bedrooms are single occupancy. All bedrooms observed to be clean and clear from obstruction. Bathroom: At 2:17pm LPA observed (6) bathrooms which are located inside of the bedrooms to be clean and in proper operation. Water temperature measured at 111.6 – 112.4 degrees Fahrenheit. LPA observed appropriate grab bars in shower and toilet area with appropriate non-skid mats in three (3) out of (6) bathrooms. (3) out of (6) residents received bed baths therefore no non-skid mats are located in those bathrooms. Bathrooms are stocked and equipped with soap and private towels use. Medications: LPA observed at 2:32pm the locked medication cabinet located in the hallway by the entrance of the facility. LPA observed the first aid kit and manual located and stored in the medication cupboard. Living, dining room and common areas: At 2:39pm LPA observed these areas to be appropriately furnished with tables and chairs and adequate lighting. Observed to be neat and clean. Activities are stored in a cupboard near the entrance of the facility. At 2:51pm the smoke detector was tested and observed to be working, it is not hard wired and interconnected throughout facility. The facility has a carbon monoxide detector located in the hallway it was tested and observed to be operational and functioning. Backyard: At 3:02am LPA observed the outside area and surrounding the facility it was clean and clear from obstruction and debris. The facility has a covered area with a table and chairs for seating, and additional table and chairs for lounging. LPA observed a swimming pool with a self-latching gate measured at 5ft with a pad lock that requires a key located on the premises to be locked during the visit. LPA observed a detached garage that is separated into two sections at 3:09pm to be locked and storing extra personal care items, incontinent supplies, PPE in one section, and the laundry machines and toxins, extra wheelchairs, walkers, and mattresses on the second section of the garage. Exit interview conducted. Copy of report, Technical Assistance issued.