Routine inspection·August 4, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 08/04/2023 at 1:05 pm. LPA was met by Staff #1 (S1) and explained the purpose of the visit. Facility is licensed to serve residents over 60 years old. The facility cares for elderly residents with dementia and is allowed to care for six (6) bedridden residents. LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), Resident Roster (LIC 9020) LPA OBSERVATIONS: Tour began at 1:11 pm and was led by S1. The facility is a single-story building located in a residential area with three (3) resident bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located kitchen cabinet, to be inaccessible to three (3) out of three (3) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to three (3) out of three (3) residents in care. Kitchen sink water temperature was measured at 135.8 degrees F. Kitchen appliances were observed to be clean and in working order. LPA Ramirez observed fully charged fire extinguisher in this area. Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed with plenty of seating and lighting. Linen Closet: Contained plenty linens, towels, and hygiene products. Resident Rooms 1 - 3: LPA Ramirez observed all resident bedrooms to contain the required linens, furnishings, and lighting. LPA Ramirez observed required auditory devices on exits. Auditory device in resident room# 2 was switched off, According to S1 resident was napping and the sound of the alarm ringing was disturbing the resident, so it was temporarily switched off. SEE 809-C Bathrooms: Signs promoting hand washing were observed. Water temperature in resident bathroom#1 was measured at 136.2 degrees F which not within the required 105 – 120 degrees F. Shared bathroom #2 was observed to be clean and water temperature was measured at 140.1 degrees F which is not within the required 105 – 120 degrees F. Centrally Stored Medications: LPA observed cabinet located in hallway to locked and inaccessible to residents in care. Only one (1) resident medication was reviewed. Backyard: LPA observed plenty of seating and shade. No large bodies of water were observed. Emergency Drills: Proof of last documented fire drill was conducted 7/20/20/23. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways. LPA Ramirez observed posted Emergency Disaster Plan. Staff Personnel Files: Staff files are maintained at facility. Four (4) staff files were reviewed. LPA Ramirez did not see annual required training for staff that have direct contact with residents. Resident Files: Three (3) resident files were reviewed. Admissions agreements, Health Screening, and resident personal rights were observed in files. Liability Insurance & Infection Control Plan: Licensee will send Liability Insurance and Infection Control Plan by 8/11/23. Deficiencies are being cited during visit. Exit interview was conducted S1 and a copy of this report, 809-D, and appeals rights were provided.