Routine inspection·December 30, 2024

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:15AM. LPA was greeted at the door by staff and the reason for the visit was explained. Licensee, Tom Stiles arrived at 11 AM. Entrance interview conducted. At 10:17AM, the LPA along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 10:17AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for expiration dates and food labels had expiration date clearly marked. Knives and chemicals were locked inaccessible in kitchen drawer and cabinet. Fire extinguisher was fully charged and last purchased 11/23/2024. BEDROOMS: There are five (5) resident bedrooms of which four (4) are for private-use and one (1) is for shared-use. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There is a staff room on premises. All direct exits were clear, and no obstructions were noted. RESTROOMS: There are three (3) restrooms of which two (1) one is for private-use, and two (2) are for shared-use. Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The restrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. Between 10:26AM – 10:35AM, hot water temperatures were measured in resident bathrooms and were between 106.9 degrees F – 107.7 degrees F, which is within the required range. Report Continued on LIC 809-C . COMMON AREAS: At the time of the visit, living room and dining room furniture were observed to be in good condition. There is one (1) fireplace which was observed adequately screened. The facility maintained a comfortable temperature. At 11:10AM, smoke detector(s) and carbon monoxide detector tested and were operational at the time of the visit. Auditory exit alarms were functioning at the time of the visit. LPA observed required postings throughout the common spaces. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate which was observed to self-latch and self-close. No bodies of water and obstructions noted. MEDICATION REVIEW: At 10:44AM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in cabinet in the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. RECORD REVIEW: Beginning at 11:11AM, LPA reviewed three (3) out of three (3) resident files and three (3) out of three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident and personnel files were in order. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted monthly, with the last drill conducted on 12/01/2024. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.