Routine inspection·August 3, 2021

On 08/03/2021 Licensing Program Analyst (LPA) Troy Agard conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. Upon arrival at the facility, LPA Agard conducted a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. The facility is licensed for six (6) non-ambulatory residents, of which one (1) may be bedridden and an approved hospice waiver for two (2) residents. Currently, there are no residents on hospice present during today’s visit. LPA met with the administrator and both toured the inside and outside grounds of the facility. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log and temperature log was observed. PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is in the back patio. LPA observed required postings at the front of the facility. LPA did not observe newly admitted residents or newly hired staff. The facility has two out of four residents with memory care needs. Potentially dangerous items, including sanitizers, are kept inaccessible to residents with dementia. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Furniture in the common area were in good repair. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew. The water temperature measured at 120.2 F. A comfortable temperature Continued on 809C was maintained in the facility. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in a locked storage cabinet. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to residents in care. One fire extinguisher was observed in the kitchen area. Outside grounds were toured. LPA observed a cascading pond in the backyard of the facility. The widest part of it is about 5 feet and the length is about 8 feet. The pond is about 2 feet deep with water that is inaccessible to residents in care. Pond was gated with hard wires. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions. No deficiencies were cited during this visit. One technical advisory was discussed with Administrator An exit interview was conducted, and a copy of this report was provided to Licensee/Administrator.