Routine inspection·June 6, 2022

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility to conduct a required annual visit. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Facility Administrator Susan Caldwell at approximately 9:15 a.m. and explained the reason for the visit. The LPA toured the physical plant areas inside and outside at approximately 9:28 a.m., with Administrator Susan Caldwell., to ensure that there are no health and safety hazards. BEDROOMS: There are (5) bedrooms designated for resident use. Bedroom #1 is single occupancy with no private bathroom and an exit to the exterior. Bedroom #2 is single occupancy with no private bathroom and no exit to the exterior. Bedroom #3 is a shared room containing two beds, two closet spaces with outdoor access and a shared bathroom. Bedroom #4 is single occupancy with a private bathroom and a direct exit to the exterior. Bedroom #5 is single occupancy with a private bathroom and a direct exit to the exterior. The facility has furnished each room with clean linens, appropriate furnishings, and sufficient lighting for resident use. BATHROOMS : Resident bathrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products however (1) bathroom was not restocked at the time of observation. The administrator stocked the bathroom immediately upon observation. Bathroom hot water measured between 110.3 degrees Fahrenheit and 114.4 degrees Fahrenheit between 9:32 a.m. and 9:50 a.m. storage space closet in hallway was observed at 9:36 a.m. containing clean linens for resident use. Continued on LIC 809-C KITCHEN/LAUNDRY: At 9:40 a.m., the LPA toured the Kitchen and Laundry area. Appliances were clean, sanitary and in operable condition. The facility has a sufficient supply of perishable and non-perishable foods. At approximately 9:41 a.m. knives were observed to be accessible in an unlocked kitchen cabinet and at approximately 9:45 a.m. knives were observed on a dish rack and accessible to residents in care. At approximately 9:42 a.m. the LPA observed a bottle of Ajax cleaning powder unlocked under the kitchen sink. The administrator confirmed that the knives were left out after it was used to prepare breakfast in the morning. The cabinets were unlocked because staff were actively using the kitchen. At the time of the LPA’s observation the kitchen was clean and unattended by staff. At approximately 9:43 a.m. the LPA observed the laundry closet containing detergent, cleaning supplies and disinfectants to be unlocked. The administrator was reminded by the LPA that cleaning supplies and knives should be inaccessible to residents and remain locked at all times. BACKYARD: At 9:53 a.m. the LPA toured the backyard area. The backyard has a covered outdoor area equipped with furniture for resident use. Furniture was observed to be in good repair. There were no bodies of water noted. The LPA observed a locked shed in the backyard which was inaccessible to residents at the time of the visit. HALLWAY: At approximately 9:43 a.m., the LPA observed a locked bathroom room in the kitchen hallway containing all centrally stored medications. Medications were observed to be locked and secured at the time of the visit. At 10:03 a.m. smoke and carbon monoxide detectors were observed in the hallway and throughout the facility. At 10:05 a.m. the administrator tested the fire alarm system and the LPA observed it to be operating appropriately in all bedrooms and common areas at the time of the visit. The fire extinguisher was observed to be full and last serviced on 3/29/2022. Continued on LIC 809-C GARAGE: At approximately 10:10 a.m., the LPA toured the detached garage which is used as the facility office. The garage was free of obstructions and the cabinets were properly secured at the time of the visit. INFECTION CONTROL: Upon entry, the facility had a central entry point for symptom screening, temperature checks, and sanitation station. There was an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time. The LPA conducted an unannounced initial 10-day complaint visit in conjunction with today's annual visit, complaint control number 29-AS-20220603152736 and cited for deficiency found regarding masking. The LPA reminded the Licensee that masking protocols are still in place including vaccination requirements, visitation, and testing protocols. An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Licensee. A copy of this report, LIC 809-D, and Appeal Rights were discussed and provided to Administrator, whose signature on this form confirm receipt of these documents.