Routine inspection·November 15, 2022

At 1:05 p.m. on 11/15/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later Administrator and disclosed the reason for the visit. LPA and staff toured the facility inside and out. The facility was last visited on 10/11/2022 for a complaint visit. It is a single story building with 5 bedrooms, 2 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 1 may be bedridden. Approved hospice waiver for 1. Upon entry, LPA observed a resident sitting under the shaded patio area with family. The facility’s visitation policy was posted at the main entrance. LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer, visitor log, and hand sanitizer. LPA observed additional postings inside, including confidential complaint contacts, Ombudsman contacts, emergency disaster plan, facility license, Administrator certificate, Personal Rights, and rights of family councils. The facility had 5 bedrooms. Bedroom #1 and Bedroom #2 were private. Bedroom #3 and Bedroom #4 were shared bedrooms. The bedroom at the front is designated for staff. No hazards were observed in the staff bedroom. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bedroom exits were unlocked and free of obstructions. All emergency exit paths were clear and free of hazards. At 1:09 p.m. LPA tested the carbon monoxide detector to be operational. LPA also observed a fully charged fire extinguisher at the main entrance. It was last inspected on 05/17/2022. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 1:16 p.m. LPA measured the room temperature to be 78.1 degrees Fahrenheit. The facility had 3 bathrooms. All bathrooms contained liquid soap, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 1:17 p.m. LPA measured the water temperature in the large, shared bathroom to be 117.1 degrees Fahrenheit. A toilet paper holder in the small shared bathroom needed to be replaced. The correction is noted on the attached LIC 9102 page LPA observed an adequate supply of perishable and non-perishable food in the kitchen. The stove hood was clean, and surfaces were sanitary. Sharps were locked below the counter top, and medications were locked above the counter. Cleaning supplies were locked in the laundry area adjacent to the kitchen. There, LPA observed an operable washer and dryer. Located between Bedroom #1 and Bedroom #2 was a closet with an adequate supply of fresh linens. At 1:55 p.m. LPA tested the smoke detector in the living room to be operational. The front yard contained shaded patio furniture in good repair. The back yard contained gardened areas. One resident was observed resting, and another resident watched television in the living room. At approximately 1:35 p.m. LPA observed staff advising Resident #1 (R1) to use their walker when walking. Staff later advised R1 to be careful when walking up the indoor ramp. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.