Routine inspection·November 30, 2023

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility 10:03 am LPA was greeted by staff and disclosed the purpose of the visit. Staff contacted the administrator. LPA conducted a tour of the physical plant at approximately 10:20 am to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common areas were observed for the ability to safely serve the needs residents. These included the living room, dining and family room combination, and kitchen. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to have adequate seating for residents. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the three (3) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. However, the meat was not properly stored in containers. Resident medications and first aid kit/supplies are stored in hall closet near laundry room. Medications observed to be locked and inaccessible to residents in care. Sharps are locked in kitchen drawer and observed to be in accessible to residents. Toxins are stored and locked in laundry room. Toxins observed to be inaccessible to residents. There is one (1) fire extinguisher attached to wall in kitchen and observed to be charged. Laundry room is located near garage. The appliances observed to be clean and functional. (Cont. from 809) The facility has a total six (6) bedrooms and (3) bathrooms. There is one (1) room for staff room. The resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens in hall cabinets. Bedroom #5 had one (1) bed with a brace attached to prevent falls. Each bathroom has the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the three (3) bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 115.1, 115.9 and 117.3 -degrees Fahrenheit. Backyard has the following: Covered patio with tables and chairs. Patio furniture observed to be in good repair. Attached Garage: Used for PPEs, toxins, and storage. Shed: Locked shed used to store equipment Smoke detectors/carbon monoxide detector were tested and operable at time of visit. Facility grounds were free of hazards. At approximately 11:20 am LPA Smith discuss with Administrator over phone the availability of facility staff records. Administrator reveals he has staff records and currently updating them. At 1:50 pm: LPA reviewed three (3) resident files. Three (3) resident files reviewed included medical assessments and appraisals. Deficiencies noted on 809D Exit Interview Conducted /Copy of the Report given.