Routine inspection·November 10, 2022

On 11/10/2022, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with House Manager Jean Seen and explained the purpose of today’s visit. The facility is licensed to operate for six (6) elderly residents ages 60 and above. The facility is approved for six (6) non-ambulatory residents of which six (6) may be bedridden and may retain six (6) hospice. The facility is a single-story structure located in a residential neighborhood. The facility consists of the following: six (6) resident's rooms, a staff room, four (4) bathrooms, a living room area, dining area and kitchen. There is a garage used for storage only. The washer and dryer are located in a closet space next to the garage. There is a patio area with an umbrella for shade and ample seating for the residents. LPA and house manager toured the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature met Title 22 requirements in the kitchen and bathrooms. A comfortable temperature was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, sharps, cleaning supplies and toxins were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. There was one (1) fire extinguisher fully charged located in the kitchen area. First aid kit was available. Smoke detectors and carbon monoxide were operable. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed five (5) residents and two (2) staff present during the tour. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. Advisory Notes – One (1) Technical Assistance were issued, please see LIC9102-AN. There was one (1) deficiency cited during this inspection visit. See 9099D page. An exit interview was conducted and a copy of this report was provided to House Manager Jean Seen.