Routine inspection·September 14, 2022

At 2:00 p.m. on 09/14/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility was last visited on 09/09/2021 for an annual visit. It is a single story building with 6 bedrooms, 2 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 nonambulatory residents, of which 6 may be bedridden. The facility uses a sprinkler system for fire safety. The facility serves residents with dementia. Approved hospice waivers for 2. Two signs were posted at the main entrance. One sign showed facility’s visitation policy and the other showed “No smoking – Oxygen in use”. Postings in the interior included Ombudsman contacts, confidential complaint contact, Administrator certificate, facility license, resident rights, facility sketch, and Emergency Disaster Plan. LPA was screened for infectious disease upon entry. The screening station contained two digital thermometers, N95 masks, hand sanitizer, face shields, and a visitor log. The visitor log included symptom checklists which tracked name, phone number, symptoms, temperature, and vaccination status. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. The living room contained workout equipment, magazines, and social-distanced furniture. At approximately 2:20 p.m. LPA measured the living room temperature to be 78 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable food. The stove hood was clean. All appliances were functional and sanitary. Sharps were locked under the counter top. At approximately 2:25 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 04/10/2022. The garage contained an operable washer and dryer, an extra refrigerator, and extra supplies. Cleaning solutions and paints were locked above the washer and dryer. The facility had 6 bedrooms, all of which were private. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. At approximately 2:25 p.m. LPA observed 3 out of 6 bedrooms contained beds with full bedrails. Staff confirmed all residents had physician’s orders for the bed rails. File review showed the facility only has hospice waivers for 2 residents. Administrator stated a waiver increase was requested. The deficiency is cited on the attached LIC 809-D page. The facility had 2 bathrooms. Both bathrooms contained liquid soap, paper towels, handwashing instruction signs, trash cans with tight fitting lids, grab bars near the toilet and shower, assistive devices, and a non-skid mat in each shower. At 3:03 p.m. LPA measured the water in Bathroom #2 to be 105.9 degrees Fahrenheit. All emergency exit paths were free from obstructions. Exit gates were unlocked. At 2:31 p.m. LPA tested the smoke detector to be operational. At 3:47 p.m. LPA tested the carbon monoxide detector to be operational. All auditory alarms were on and functioning. The back yard was maintained and had a garden and covered patio furniture in good repair. Exit interview conducted. Copy of report, appeal rights, and citation issued.