Routine inspection·December 13, 2022

Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. Upon arriving at the facility, LPA met with Samantha Alex (Administrator) and explained the purpose of the visit. FACILITY IS LICENSED TO SERVE 6 NON-AMBULATORY RESIDENTS AGE 60 AND ABOVE. HOSPICE WAIVER APPROVED FOR 1 RESIDENT. The facility is located in a residential area. A tour of the single-story facility includes: 2 Living rooms, kitchen, dining area, 5 resident bedrooms, 1 staff bedroom, 4 bathrooms, 1 office, outdoor kitchen/laundry area and a detached storage room. During today's visit, LPA observed the following: Facility shall not operate over capacity or beyond any conditions and limitation on the license. All bodies of water will be appropriately secured. Facility maintain a comfortable temperature for residents. All outdoor and indoor passageways are kept free of obstruction. Licensee ensure presence of grab bars for each toilet, bathtub and shower used by residents. Bathtub/shower have non-skid mats. Minimum of one week supply of nonperishable foods and 2 days of perishable foods was observed. Staff assisting residents with ADLs has required training. Staff responsible for direct care and supervision have current first aid training. A certified administrator is on the premise for a sufficient number of hours to manage and oversee the business operation. Medications is given per the physician’s directions. Centrally stored medicines is kept in a safe and locked place. Smoke detector and Carbon monoxide detector is operable. Fire extinguisher is fully charged. Resident #2, #3, #4's medical assessment does not contain tuberculosis test results. Per Title 22 Regulations, the deficiencies observed are documented on LIC809D. Failure to correct the deficiencies may result in civil penalties. An exit interview was conducted and a copy of this report and appeal rights provided to Samantha Alex.