Routine inspection·March 3, 2025

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Designee Lydia Olila and explained the reason for the visit. At approximately 10:45 am, with the assistance of Staff#2 (S2), LPA took a tour of the physical plant. Required postings were observed in the entry area. The fire extinguisher is located in the dining area. The purchase date is March 3, 2025. LPA tested the smoke alarms and found that they function properly. The carbon monoxide detector was tested, and it functions properly. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were four (4) bedrooms designated for residents' use. Two (2) bedrooms are designated for private use, and two (2) rooms are shared. All four bedrooms in use by residents were properly furnished with appropriate beddings and linens and with sufficient lighting. Bathrooms: There are three (3) bathrooms designated for residents' use. All three bathrooms were properly supplied and had functional fixtures. The hot water temperature from the bathroom sink was measured at 112.3 and 113.8 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry room: The Laundry door is locked, and thus, chemical hazards are inaccessible to residents. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. LPA observed that R2 has no updated Physician Report. R3 has an incomplete physician Report. LPA also observed that there's no hospice care plan for R4, indicating the need for the full rails. LPA observed R1, R2, and R3 have 1/2 bed rail without physician order. (Continue on 809 C) Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. LPA observed that there's no physical file for the Administrator. Medications: Medication and Medication Records were reviewed for proper documentation. Exit Interview conducted, citations issued, appeal rights given, and copy of this report signed and delivered.