Routine inspection·January 30, 2025

At 9:45 a.m. on 01/30/25, Licensing Program Analysts (LPA) Nicholas Reed and Nadia Shahbazian conducted an unannounced complaint visit. LPA met with staff and later the administrators and disclosed the reason for the visit. The facility was last visited on 03/16/2024 for an annual visit. It is a single story building with six (06) bedrooms, two (02) bathrooms, kitchen, laundry area, common areas, and outdoor space. It has an approved fire clearance for six (06) nonambulatory residents. Approved hospice waivers for six (06). LPAs observed a maintained front yard with an unlocked entry gate. A screening station at the front contained sanitizer, a digital thermometer, and a visitor log. Postings at the front included COVID precautions, facility license, confidential complaints contacts, ombudsman contacts, emergency disaster plan, rights of resident councils, personal rights, and the facility sketch. Cameras were observed in the common areas and exterior areas. Walls, floors, windows, and screens were clean and in good repair. The living rooms contained a television, a piano, and furniture in good repair. Confidential files were locked in a cabinet near the television. The facility has six (06) bedrooms. Bedroom #6 is designated as a staff room. The staff room was unlocked and free of hazards. All bedrooms contained a chair, lamp, nightstand, a dresser, and a bed with adequate bedding. All furnishings were clean and in good condition. All rooms with hospital beds had wheels in the locked position. Half bed rails were observed in Bedroom #1 and Bedroom #2. Full bed rails were observed in Bedroom #3 and Bedroom #5. The facility has two (02) bathrooms. One (01) bathroom is private to Bedrooms #5, and one (01) is shared. All bathrooms contained liquid soap, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 10:05 a.m., LPAs observed hazardous cleaning supplies below the sink in the shared bathroom were accessible. At 10:10 a.m. LPAs observed two (02) shaving razors on the nightstand in Bedroom #2. LPAs also saw an accessible shaving razor in the private bathroom to Bedroom #5 at approximately 10:15 a.m. A deficiency is issued for accessible sharp objects and cleaning supplies on the corresponding LIC 809-D page. At approximately 10:20 a.m. LPAs measured the water temperature in the shared bathroom to be 117.5 degrees Fahrenheit. At 10:25 a.m., dual purpose smoke and carbon monoxide detectors were tested and operational. At 10:30 a.m. LPAs measured the room temperature to be 69 degrees Fahrenheit. Around 10:35 a.m., LPAs observed a smoke detector in the hallway near Bedroom #1 to be operational but not secure to the wall. At the same time, LPAs observed the two hallway air vents were in need of light cleaning. Also, blinds in the kitchen needed light cleaning. These Technical Violations are noted on corresponding LIC 9102-TV pages. LPAs called out from the house telephone at 10:40 a.m. The phone was deemed operational. LPAs observed an adequate supply of perishable and non-perishable foods in the kitchen. Appliances were in good condition. Sharps and cleaning solutions were locked under the sink and counter top. Medications, emergency lighting, and a complete first aid kit were locked above the counter top. At approximately 10:50 a.m. a fully charged fire extinguisher was observed in the kitchen. It was last inspected on 01/21/25. The stove surface was clean. A washing machine and dryer were located in the laundry area adjacent to the kitchen. Both were in working order. Detergents and cleaning supplies were locked near the appliances. LPAs observed a patio area in the rear of the facility. The patios contained a shaded area with chairs. The back yard was maintained. The garage and a storage shed were locked and inaccessible. All emergency exit paths were free from obstructions. Three (03) out of three (03) exit gates were unlocked. Two (02) out of two (02) auditory alarms were turned on and functioning. At 11:30 a.m. LPAs reviewed staff and resident files. Review of staff files revealed Staff #1 (S1) did not have a tuberculosis test on file. A deficiency is cited on the corresponding LIC 809-D page for S1 not having a tuberculosis test prior to employment. Four (04) out of five (05) resident files needed Needs and Service plans updated, so a Technical Violation is assessed for this update on the corresponding LIC 9102-TV page. Exit interview conducted. Appeal rights discussed. Copy of report provided.