Routine inspection·March 16, 2024

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced annual iinspection at this facility at 10:10 am. LPA Smith contacted Licensee (Martin Zinkofsky) by telephone and requested to have staff open door. Licensee stated will have staff open door. LPA was greeted by staff and disclosed the purpose of the visit. The administrator was not present at the facility upon LPA Smith arrival. 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 kitchen/dining room combination, living room and family room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately with 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 six (6) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked kitchen drawer. The resident medications and first aid kit stored in locked cabinet next to refrigerator and observed to be locked and inaccessible to residents. There is one (1) fire extinguisher attached to kitchen wall and observed to be charged. Laundry room is located in walk through next to kitchen The appliances observed to be functional. Toxins stored in locked floor cabinet next to dryer and was observed to be locked and inaccessible to residents. The facility has a total of six (6) bedrooms and two (2) bathrooms: there is one (1) shared and four (4) private bedrooms for residents and one (1) bedroom for staff. (Cont to 809C) (Cont. from 809) 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 closet. Each bathroom had the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for in bathrooms to ensure it within the required range for residents’ comfort and safety. The water temperature range was measured at 115 and 119.5-degrees Fahrenheit for main bathroom shower. There is no body of water in the facility. Backyard has the following: (1) one patio table, with seating. Patio furniture observed to be in good repair. Administrator arrived at approximately 10:55 am and unlocked detached garage for LPA to observe. Detached Garage: Used for storage of equipment and furniture. Storage shed used for storage in backyard observed to be locked and inaccessible to residents. Smoke detectors/carbon monoxide detector were tested and operable at time of visit. Facility grounds were free of hazards. There were no immediate health and safety hazard observed during the day of inspection. At approximately 10:50 am, LPA reviewed files for the six (6) residents. Resident files included medical assessments, Appraisal/Needs and services plans, admissions agreements. One (1) of six (6) resident files had an incomplete physician’s report in addition to not having physician's signature. Staff documents reviewed for two (2) staff. Staff files had the appropriate training's and current CPR training. Technical advisory for frayed back screendoor. Deficiencies cited on 809D Exit Interview Conducted / A Copy of the Report Issued.