Routine inspection (multi-day)·June 30, 2025

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent Required- 1 year visit. LPA met with Greg Tillman, Administrative Assistant and explained the purpose of the visit. Shortly after, Ian Baker, Administrator arrived and assisted LPA with the inspection. There are currently thirty four (34) residents residing in the facility. Facility is licensed to serve elderly residents age 60 and above, fire clearance approved for (72) non-ambulatory. Hospice approved for ten (10) residents, 87705 compliant. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant/Environment Safety: The facility is a 2-story building located in a residential community. The facility consists of: First floor: Lobby, Administrative offices, Conference room, Supply room, Power/Telephone room, Kitchen, Janitor room and Elevator. Second floor: (36) resident bedrooms, Medication room, Library, Activities room, Staff room, Beauty shop, Doctor's office/Nurse station and Dining room. The interior and exterior physical plant was inspected. Kitchen was inspected, knives, sharps objects, cleaning supplies and toxic substances are inaccessible to residents. Exit doors are free of any obstruction and there are no pools or large bodies of water. There are cameras without audio in the hallways and common areas. Smoke alarms and carbon monoxide were tested and operable. There are no firearms or weapons stored at the facility. LPAs tested hot water temperature in random resident rooms and water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Staffing: A total of twenty (20) staff members including the Administrator provide care and supervision to the residents. Staff employed are over the a ge of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. *****CONTINUED ON LIC809-C***** Personnel Records/Staff Training: LPA reviewed (5) staff files and confirmed health screenings and fingerprint clearances. Proof of staff training, health clearance, vaccinations and First Aid/CPR training, however (2) out of (5) staff have expired First aid/CPR training. Administrator's certificate expired on 01/12/2025, but renewal has been submitted. Resident Rights-Information: Resident personal rights are posted. Notice of visiting policy is posted. Facility provides internet services to all residents and have access to the facility phone. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. LPA observed the activities calendar posted in the activity room and displayed on the tv screen by the elevator. The facility has a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Cleaning supplies are stored in areas separate from food supplies. Sanitation practices and kitchen cleanliness was observed. Incidental Medical and Dental: Resident medications were reviewed; centrally stored and containing 30-day supply of medications. Medical and dental transportation is provided. Resident Records/Incident Reports: Resident files are maintained at the facility. A total of (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, medication records, and P & I money records. RCFE complaint poster and Personal rights were observed posted. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. Residents with Special Health Needs: No hospice and/or bedridden residents. There are no residents using oxygen. No residents have prohibited health conditions. Deficiency issued on LIC809-D. An exit interview was conducted, and a copy of this report was provided to Ian Baker, Administrator along with the Appeals Rights.