Routine inspection·June 20, 2022

At 9:45 a.m. on 06/20/2022, 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 05/06/2022 for a complaint visit. It is a single story building with 6 bedrooms, 4 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 5 may be non-ambulatory and 1 may be bedridden in Bedroom #6. The facility serves residents with dementia. Approved hospice waivers for 6 residents. The facility uses surveillance cameras inside. Entry: The front yard was well-maintained. Signs were posted at the main entrance for the facility’s COVID policies. Near the dining room table were postings for resident rights, resident councils, Ombudsman contact, confidential complaints, and Emergency Disaster Plan. A sign showing “Oxygen in Use – No Smoking” Hung on the rear entrance door. Screening: LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer and a visitor log. The visitor log tracked contact tracing information, symptoms, and temperature. LPA advised staff to also track proof of vaccination or a negative COVID test. Bedrooms: The facility has 6 bedrooms. 5 are private and 1 is shared. One private bedroom is designated for staff. The staff bedroom was locked and free of hazards. Bedroom #1 remains locked by resident preference. Bedroom #4 is the shared bedroom and has a divider. Bedroom #5 was locked, but staff unlocked the room during the visit. All bedrooms contained a chair, nightstand, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Emergency evacuation routes were posted in each room and clearly labelled. Bathrooms: The facility has 4 bathrooms. 2 out of 3 bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can, grab bars near the toilet and shower, and a non-skid mat in the shower. Due to residents with dementia and a lack of hazard awareness, the facility provides paper towels and soap when residents use the bathroom. Kitchen: LPA observed an adequate supply of perishable and non-perishable food. The facility also stores more food in a garage near the main office. The stove hood was clean. Medications were locked by the refrigerator. Sharp objects were locked by the sink. Cleaning solutions were locked by the refrigerator. Staff kept the keys with them. Laundry: LPA observed a washer and dryer in good condition near the dining room. Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. A fireplace had an appropriate covering. 2 residents were observed sitting and watching television. 1 resident played a game with staff. Safety: All emergency exit paths were free from obstructions. 2 exit gates were unlocked and led to the main street. At 10:18 a.m. staff opened the sliding exit door in Bedroom #5. LPA heard the auditory alarm function. Ramps with secure hand rails led out from Bedroom #5 and Bedroom #6. At 10:37 a.m. LPA tested the smoke and carbon monoxide detector to be operational. When tested, the fire door by Bedrooms #3, #4, and #5 closed automatically. At 42 a.m. LPA observed a fully charged fire extinguisher near the laundry area. It had a receipt taped to it from 05/03/2022. LPA observed a sufficient First Aid Kit in the kitchen. Outdoor areas: LPA observed a safe walkway in the back yard free of tripping hazards. A covered patio area contained furniture in good condition. A detached garage was locked. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.