Routine inspection·June 12, 2024

At 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual inspection. LPA met with the staff and Administrator contacted and LPA explained the reason for the visit. Administrator arrived at the facility shortly after. LPA and Administrator toured the facility inside and out. The facility is a single story building with seven (7) bedrooms, four (4) bathrooms, kitchen, dining room, office, garage, storage areas, common areas, and outdoor areas. It has an approved fire clearance for six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility serves residents with dementia. Hospice waivers approved for two (2) residents. Kitchen: At 10:15, LPA observed that the kitchen contained a freezer, a refrigerator, and two pantries. LPA observed an adequate supply of perishable and non-perishable food. Sharp objects were locked near the stove. Cleaning solutions were locked in a cabinet next to the kitchen. Medications: Medications were locked near the kitchen in a cabinet. However, LPA observed a full box with seven full bottles of Hair, Skin, and Nail 5,000 mg supplement in bedroom # six (6) in the closet accessible to residents in care. Additionally, LPA observed empty bottles of wine in room # six (6) in the closet. Bedrooms: The facility has seven (7) private bedrooms. One (1) bedroom is designated as a staff room. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. Bedroom # three (3) and bedroom # five (5) furnishings were clean, odorless, and in good condition. However, Bedroom # one (1), room # six (6), and room # four (4) furnishings and surroundings were not sanitary and clean. In bedroom # six (6), LPA also observed Lysol disinfectant spray bottle almost full accessible to resident in care. Continue on LIC 809C Bathrooms: The facility has four (4) bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 10:31 AM, LPA measured the water temperature in the shared bathroom to be 117.5 degrees Fahrenheit. Garage: The garage was locked from the outside. It contained a washer, dryer, paper supplies, extra water bottles, and detergents. Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 10:35 A.M. LPA measured the living room temperature to be 76 degrees Fahrenheit. Seating was arranged in the living room to accommodate physical distancing. Extra linens were kept in a storage closet between the kitchen and the staff room. Safety: At 10:45 AM, LPA observed a fully charged fire extinguisher in the kitchen and was purchased on 10/10/2023. All emergency exit paths were free from obstructions. Exit gates were unlocked. At 10:50 AM, . LPA tested four (4) out of four (4) smoke detectors to be operational. Smoke detectors were hard wired. LPA tested the carbon monoxide detector to be operational. LPA heard four (4) out of four (4) auditory alarms on and functioning during visit. Outdoor areas: At approximately 11:00 AM, LPA observed staff maintaining the front yard. All outdoor areas were free from debris. A locked shed was located in the back yard. All furniture was clean and in good repair. Between 12:10 PM to 1:30 PM, LPA reviewed records of five (5) residents and three (3) staff. Residents and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Deficiencies cited during today’s visit. Appeal rights explained. Exit interview conducted and copy of this report signed and delivered.