Routine inspection·September 29, 2022

At 10:20 a.m. on 09/29/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out. The facility was last visited on 10/19/2021 for a case management visit. It is a single story building with 4 bedrooms, 3 bathrooms, kitchen, pool, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 4 may be non-ambulatory and 1 may be bedridden in Bedroom #4. The facility serves residents with dementia. Approved hospice waivers for 4. LPA observed a sign posted at the front for “No Smoking – Oxygen in Use”. LPA was screened for infectious disease upon entry. LPA signed in on the visitor log, Staff added columns on the visitor log to track temperature, symptoms, and vaccination status during the visit. Postings at the main entrance included confidential complaint contacts, emergency contacts, personal rights, facility license, non-discrimination policy, and COVID precautions. The facility had 4 bedrooms. 1 is private and 3 are shared. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Beds in shared rooms were at least 6 feet apart for social distancing. LPA observed 7 beds in the facility, and staff confirmed that only 6 will be used. Staff confirmed their understanding of their capacity limitation. Bedroom #4 was cleared for a bedridden resident. Bedroom #4 was vacant. The fire door to Bedroom #4 is not properly suspended with a magnet. Instead, the fire door was shut. LPA explained to staff that the door must be suspended by a magnet and secured properly before a resident moved in to the room. At approximately 10:35 a.m. LPA observed an auditory alarm removed from the rear sliding door. Staff confirmed it was broken. Outside, LPA observed a pool gate without a lock, 6 paint cans near the pool, and a storage shed with cleaning solutions unlocked and accessible. Staff locked the pool gate, placed the paint cans in storage, and locked the storage shed. Ramps and handrails were in good condition. Fireplace was covered appropriately. The facility had 3 bathrooms. All bathrooms contained liquid soap, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. Staff stated that toilet paper and paper towels are provided with each use due to residents with impulse control issues. At 10:40 a.m. LPA measured the water temperature in the private bathroom of Bedroom #4 to be 120 degrees Fahrenheit. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 10:50 a.m. LPA measured the room temperature to be 76 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable food in the kitchen. At 10:52 a.m. LPA measured the refrigerator and freezer temperatures to be 40 and 0 degrees Fahrenheit, respectively. Kitchen appliances were sanitary and functional. Sharps were locked below the counter top. A washer and dryer in good condition were located near the kitchen. At approximately 10:54 a.m. a cleaning solution was found in the bathroom adjacent to the kitchen. Staff immediately locked the cleaning solution in the storage shed. All emergency exit paths were free from obstructions. Exit gates were unlocked with inward facing latches. Emergency Disaster Plan posted at the front. At 11:16 a.m. staff tested the dual-purpose carbon monoxide and smoke detectors in Bedroom #4 to be operable. Detectors were hardwired and functioned simultaneously. An additional verbal alert sounded when detector was tested. At 10:30 a.m. LPA observed a fully charged fire extinguisher near the kitchen, It was purchased on 09/30/2021 and had a receipt attached. During today's inspection, the facility was not in compliance with Title 22 regulations. Citations issued on LIC 809-D page. Exit interview conducted. Copy of report, appeal rights, and citations issued.