Routine inspection·November 8, 2024

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit on 11/08/2024. LPA was greeted by the caregiver. The facility is licensed for six ambulatory residents and there are five residents living in the facility. LPA Spaeth viewed the residents' records at 9:30 am until 10:15 am. LPA Spaeth reviewed resident's medication at 10:15 until 10:30 am. LPA reviewed staff files at 10:30 am until 10:40 am. LPA Spaeth and the caregiver began the tour at 9:40 am until 10:13 am. LPA observed the following: Common areas – The living room and family room contained comfortable seating. The dining room contained a dining room table and chairs. Kitchen – LPA observed a two-day supply of perishable food and a seven-day supply of non-perishable food. There were no cleaning solutions stored underneath the kitchen sink. A fire extinguisher was located in the kitchen area. Pantry Room - The pantry room was locked and contained canned goods on one side of the room and cleaning solutions on the other side of the room. The washer and dryer were located in the pantry room. Garage – The garage was locked. There were no hazardous items in the garage. Continued on 809-C Resident Rooms - LPA observed the resident rooms contained bed, linens, night stand, lamp, closet and chest of drawers. Medications - The medications were locked in a two drawer cabinet located in the dining room. Resident files - The residents' files were locked in a two drawer cabinet located in the dining room. Staff Room - The staff room was locked. Bathrooms – LPA observed the bathrooms contained hand soap, paper towels, and covered trash cans.. Water Temperature – LPA tested the water at 11:50 am and was 116.0 degrees F. Smoke/Carbon Monoxide Detectors – The smoke and carbon monoxide detectors were tested at 10:45 am and were operable. Backyard - LPA observed the backyard which has a shaded area. The gate leading from the backyard to the front yard was not locked. There are no deficiencies to report at this time. Exit interview conducted and a copy of the signed report was given.