Routine inspection·August 22, 2024

At approximately 9:00 a.m. on 08/22/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Staff #1 (S1) and disclosed the reason for the visit. LPA and S1 toured the facility inside and out. The facility was last visited on 09/14/22 for an annual visit. It is a single story building with six (06) bedrooms, four (04) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which six (06) may be bedridden. The facility serves residents with dementia. Approved hospice waivers for four (04). Surveillance cameras are used in common and exterior areas. The front entrance is gated and unlocked. Seating areas were observed at the front and rear of the facility. At the front door, LPA observed postings for the house rules, facility sketch, administrator certificate, facility license, emergency disaster plan, COVID precautions, personal rights, theft and loss policy, rights of resident councils, confidential complaint contacts, ombudsman contacts, and oxygen in use signs. A screening station at the front contained a visitor log, sanitizer, and masks. Walls, floors, windows, screens, and blinds were clean and in good repair. At 9:20 a.m. LPA measured the room temperature to be 78 degrees Fahrenheit. The living room contained a television, reading materials, and furniture in good repair. At 9:30 a.m. the house telephone was called and deemed operational. The facility has six (06) bedrooms. One (01) bedroom is designated as a staff room. The staff room was free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Residents with half-bedrails had prescriptions in their facility files. Exit doors from rooms were unlocked. All auditory alarms were tested and functioning. Ramps leading out were secure, and emergency exit paths were free of debris or hazards. The seating area in the rear was shaded. The back yard also contained a gardened area and an unlocked exit gate. The storage shed was locked and contained tools and chemical cleaners. A separate living area contained a piano and a treadmill. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen refrigerator and freezer as well as the garage and garage refrigerator. Appliances were in good condition. Sharps were locked below the counter top. Cleaning solutions were locked below the sink. Medications and confidential files were locked in separate cabinets. The garage was unlocked and contained a washing machine, a dryer, and extra supplies. Both appliances were in working order. Detergents were locked above them in a cabinet. The facility has four (04) bathrooms. One (01) bathroom is private, and three (03) are shared. All bathrooms contained liquid soap, trash cans with tight fitting lids, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 10:15 a.m. LPA measured the water temperature to be 105.1 degrees Fahrenheit in the shared bathroom. At approximately 10:20 a.m., smoke and carbon monoxide detectors were tested and operational. At approximately 10:25 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 09/18/23. At 10:40 a.m. LPA conducted a records review of resident and personnel files. Most files were complete and available for audit. During record review, it was discovered that four (04) out of five (05) residents had incomplete consent forms and property and valuable forms. Deficiency is issued on the corresponding LIC 809-D page. Additionally, Resident #1 (R1) did not have a test for Tuberculosis in their file. Interview with S1 at 11:20 a.m. revealed R1 was not tested for Tuberculosis. Deficiency is issued on the corresponding LIC 809-D page Exit interview conducted. Appeal rights discussed. Copy of report provided.