Routine inspection·December 9, 2024

At 11:40 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual visit. LPA met with staff and later Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility is a single story building with 5 bedrooms, 3 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 5 may be non-ambulatory. The facility serves residents with dementia. Approved hospice waivers for 5. Kitchen: At approximately, 11:50 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. Kitchen surfaces were sanitary, and all appliances were functional. Sharps were locked below the counter, and cleaning solutions were locked in separate cabinet in the kitchen. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 10/02/2024. Medications: At approximately, 11:55 AM LPA observed medications are centrally stored and locked in the front entrance/office of the facility in a cabinet. LPA also observed an additional locked cabinet where resident and staff files are kept. Bedrooms: LPA observed total of five (5) bedrooms designated for resident use. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has awake staff. Bathrooms: LPA observed three (3) bathrooms and all bathrooms appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and resident's bathroom had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. At 12:13 PM, hot water temperature measured at 116.2°F. Continue on LIC809-C Common Areas : The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. LPA observed an operable washer and dryer in locked room next to the garage. All detergents were stored and locked. The garage was also observed locked, which had extra emergency food and cleaning supplies stored inside. Smoke detectors/carbon monoxide . At 12:20 PM, LPA tested the dual-function smoke and carbon monoxide detector to be operational. When tested, 3 out of 3 detectors functioned simultaneously, and the fire door closed. 2 out of 2 auditory alarms were on and functioning. Outside areas: At approximately, 12:25 PM LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is no bodies of water or swimming pool at the facility. All emergency exit paths were free from obstructions. Exit gates were unlocked. Between 12:30 PM to 1:30 PM, LPA reviewed records of five (5) residents and two (2) staff. Resident and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency cited during today’s visit. Exit interview conducted and copy of this report signed and delivered.