Routine inspection·November 2, 2021

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced annual required visit. LPA met with facility staff and explained the reason for this visit. At approximately 11:05 am a physical plant tour was started the LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. The following was noted: Facility is a single story residence and consists of a total of six (6) bedrooms and three (3) bathrooms. Four (4) rooms are designated for resident use and two (2) are designated for staff use. Facility has dementia residents. All exit signal alarms were tested all exit alarms observed to be operable during visit. Smoke detectors and Carbon monoxide detector were tested and functioned properly during time of visit. Fire extinguishers were observed to be fully charged with services tag. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are stored in a locked drawer. Cleaning supplies observed inaccessible locked up in the kitchen and laundry cabinets. Bedrooms: The resident bedrooms were properly furnished with at least one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: All bathrooms observed properly supplied; with grab bars and non-skid mats installed . Residents have sufficient amounts of supplies for personal hygiene. LPA measured the hot water in bathroom used by residents (in hallway) and observed water temperature to be 117 degrees F. Common Areas : These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed furnished appropriately. Surrounding Grounds (Outdoors): There is a shaded area with furniture for outdoor use. Pool gate observed locked during today's visit. Storage rooms and garage observed in the backyard area.