Routine inspection·February 22, 2022

Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Administrator Nathaniel Hemedes and explained the reason for the visit. Physical Plant was toured, clients files and medication records were reviewed, staffs files records reviewed and food supply was inspected. The facility is licensed for six (6) residents over the age of 60, with a hospice waiver for two (2) residents , and currently has one (1) resident on hospice. The facility is a single story structure located in a residential neighborhood. It consists of the following: 3 resident bedrooms, 2 full bathrooms, living room, kitchen, dining area, laundry room, backyard with shaded patio area, and a detached garage. The garage used as office. Facility sketch did not include a garage . . Front yard is landscaped with grass. The home has a backyard area with shaded patio furniture. LPA and Administrator toured the facility. LPA observed that the facility does not have a swimming pool or other bodies of water. All indoor and outdoor passageways were free of obstruction. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask during this visit. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. LPA observed sufficient supply of perishable and non-perishable foods. Sharps, cleaning supplies are locked and inaccessible to residents. Battery operated smoke detectors and carbon monoxide detector were in compliance and operational. The facility is equipped with a fire pull alarm. Fire extinguishers are fully charged. The common areas (dining room, living room) appeared to be clean and were properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. Continue LIC809C The bathrooms are clean and operational w/grab bars and non-skid surface/mats in place. The hot water temperature was tested and maintained within the required range of 105-120*F. LPA observed the centrally stored medication area to be locked and inaccessible to residents. The first aid kit was observed and found to be in compliance with the Title 22 Regulations. LPA reviewed 3 resident files to confirm emergency contact is updated. Residents medications reviewed. Medications documented properly and stored appropriately. LPA also reviewed staff files to confirm health screenings and fingerprint clearances. All staff files reviewed were fingerprint cleared. Administrator file was not observed. The backyard had discarded furniture ( shovels, gardening tools, pieces of wood, chairs) and other hazards. Based on this inspection, deficiencies were observed at this time in the areas evaluated. See LIC 809D for deficiencies. Exit interview conducted with Administrator and a copy of the report with Appeal Rights were provided.