Pre-licensing visit·October 13, 2022

At 3:02 p.m. on 10/13/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an announced prelicensing visit. LPA met with Administrator and Licensee and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. This prelicensing inspection is for a change of ownership with residents in care. 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 nonambulatory residents, of which 1 may be bedridden in Bedroom #1 or Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for 6. LPA observed a maintained front yard with unlocked gates. Mosquito nets were hung on the front and rear doors. LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer, surgical masks, hand sanitizer, and a visitor log which tracked temperature and vaccination status. Facility postings included COVID precautions, Administrator certificate, rights of resident councils, rights of family councils, resident rights, confidential complaint contacts, emergency contacts, Ombudsman contacts, non-discrimination policy, and theft and loss procedure. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 3:10 p.m. LPA measured the room temperature to be 78 degrees Fahrenheit. The living room contained furniture in good repair. A linen closet in the hallway had an adequate supply of fresh linens. A storage closet in Bedroom #3 was locked and had incontinence supplies, paper supplies, PPE, and cleaning supplies. At 3:17 p.m. staff tested the call system to be operational. Resident files and staff files were locked in a cabinet the dining room. Medications were locked in a separate cabinet in the dining room. More cleaning supplies were locked and adjacent to the living room. A washer and dryer in good condition were located in the hallway. The facility had 5 bedrooms. 4 were private and 1 was shared. Bedroom #1 and Bedroom #5 had immediate exits which were free from obstructions and unlocked. Bedroom #3 had a private bathroom. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. The facility had 3 bathrooms. Resident bathrooms contained liquid soap, paper towels, 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. The staff bathroom, located between Bedroom #1 and Bedroom #2, did not have grab bars in the shower. At 1:23 p.m. LPA measured the water temperature in the hallway shared bathroom to be 115.7 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable food in the kitchen and pantry. Kitchen appliances were functional and surfaces were sanitary. Sharps were locked magnetically below the counter top. The facility menu was posted on the side of the refrigerator. All emergency exit paths were free from obstructions. At approximately 3:30 p.m. LPA tested the dual purpose smoke and carbon monoxide detector by Bedroom #2 to be operational. When tested, 3 out of 3 detectors functioned simultaneously. At 4:15 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was purchased on 10/28/2021. At approximately 3:45 p.m. LPA observed a fully stocked first aid kit. All auditory alarms were on and functioning. LPA observed a maintained back yard with a covered patio area. The patio area contained furniture in good condition. Additionally, a storage shed contained assistive equipment. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Administrator and LPA reviewed Component III. Pre-Licensing is complete and this facility has no deficiencies. Exit interview conducted. Copy of report provided.