Routine inspection·March 30, 2022

At 3:20 p.m. on 03/30/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility has an approved fire clearance for 6 non-ambulatory residents, of which 1 may be bedridden in bedroom #2. The facility has hospice waivers for 3 residents. The facility uses surveillance cameras at the front, back, and inside of the facility. A current resident has a small white dog. The facility serves residents with Dementia. Entry: The facility uses an unlocked, rolling gate to secure the front perimeter. At the front entrance, LPA observed a maintained yard, hand sanitizer, and postings for COVID policies, visitation policies, the most recent Provider Information Notice (PIN), and a “No Smoking – Oxygen in use” sign. Staff took LPA’s temperature upon entry. Staff recorded name and temperature in a visitor log. Once inside, LPA observed postings for Ombudsman contacts, confidential complaints, resident rights, resident councils, facility license, and administrator certificate. Bedrooms: The facility has 4 bedrooms. 3 bedrooms are shared. One bedroom is designated for staff. All bedrooms contained a chair, nightstand, dresser or storage, lamp, and beds with adequate bedding. All rooms were clean and in good repair. Bedroom #1 is a staff room. LPA observed the room was locked with bug spray inside. The spray was inaccessible to residents. Bedroom #2 and Bedroom #3 had access outside with a ramp leading to the back yard. Bathrooms: The facility has 2 bathrooms. One is designated for residents, and the other is designated for staff. Both bathrooms contained liquid soap, paper towels, handwashing instruction sign, and a trash can with a tight fitting lid. The resident bathroom also contained grab bars by toilet and shower and non-skid flooring in the shower. At approximately 3:40 p.m. LPA observed shaving razors in a drawer in the resident bathroom. Administrator confirmed a resident uses the razors to shave. LPA also observed a hole in the wall above the mirror. Common Areas: Walls, floors, ceilings, and windows were all clean and in good repair. 4 residents were observed watching television in the living room. LPA observed a resident schedule hung on the wall. LPA observed a linen closet with an adequate supply of clean beddings and towels. Kitchen: Staff were cooking food in the kitchen during inspection. Medications were locked in a cabinet in the kitchen. Medication was also stored in a lockbox in the refrigerator. Cleaning solutions were locked. The facility had an adequate supply of perishable and non-perishable food. Safety: 4 out of 4 auditory alarms were on and heard during inspection. A fully charged fire extinguisher was observed in the kitchen. It was last serviced on 08/27/2021. The facility has one fire door by resident bedrooms which was operable during test. At approximately 4:00 p.m. LPA tested smoke and carbon monoxide detector in the main hallway. 4 out of 4 facility smoke detectors were heard functioning. At 3:53 p.m. LPA measured water temperature in the resident bathroom at 133.1 degrees Fahrenheit. Staff retested the water temperature and confirmed the temperature. The handrails to the outdoor ramp were secure. Outdoor spaces: The back yard was maintained and free from hazards. Exit routes were clear. The exit gate had an outward facing latch. LPA could not open the gate. During today's visit, the facility is not in compliance with Title 22 regulations. Citations issued on LIC 809-D. Exit interview conducted. Copy of report, appeal rights, and citations issued.