Routine inspection·February 12, 2024

Licensing Program Analyst (LPA) Lorena Casillas met with back up administrator Stephen Racine for an unannounced one (1) year Required visit for this facility. LPA arrived at 09:30 am and was greeted by Administrator. All four (4) residents were present and in their rooms. LPA informed the Administrator of the purpose of the visit. Infection control: LPA previously reviewed the facility mitigation plan (approved on 04/ 1 5/21) to make sure the licensee was following current infection control recommendations. A tour of the physical plant was conducted with the Administrator at 9:50 am. The facility has six (6) bedrooms and two (2) bathrooms currently occupying four (4) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for six (6) ambulatory of which five (5) can be non-ambulatory, and a hospice waiver for four (4). Currently the facility two (2) residents on hospice. Food Inspection: LPA conducted a tour of the kitchen around 10:00 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed all knives and sharp objects being locked and inaccessible to residents in care. The files and medication cabinet was observed to be locked and inaccessible to residents in care in a separate locked room near the entrance. There is a pantry located in the hallway that has a fridge for additional food storage. Continued on LIC809-C Resident Rooms: LP A observed rooms to have the appropriate bedding. There is a night stand, a chair and sufficient lighting for each client . Bathrooms: LPA observed all bathrooms to have non-skid mats, grab bars, and the appropriated wash your hands signs posted. Hot water was tested and measured within regulation at 111.8 degrees F. Living and dining: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a temperature of 71°F. The dual smoke detectors and carbon monoxide detectors were tested and observed to be operational. There are two (2) fire extinguishers, one (1) is in the kitchen and one (1) is in the hallway. The Fire extinguishers were observed to be full and last purchased on 9/15/23. LPA observed the laundry room to not have any chemicals or hazardous items. Physical environment: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients . No bodies of water on the premises. Administrative: Annual fee is current. Administrator Certificate, LIC 500, Liability Insurance, and Client roster were collected. Resident Files : LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files : LPA conducted a file review of staff records to ensure compliance of licensing forms. Medications : LPA and Administrator reviewed medication and medication records for proper documentation. Staff Interviews : At 12:38 pm LPA interviewed staff. Client Interviews : At 12:52 pm LPA interviewed clients. An exit interview was conducted, and a copy of this report was given to the Administrator.