Routine inspection·January 17, 2023

Licensing Program Analyst (LPA) Mario Leon conducted an unannounced required annual visit with a primary focus on Infection Control measures. Upon arrival at the facility, LPA met with Joy Black, Co-Administrator (CA1) and the purpose of today's visit was explained. LPA and CA1 took a tour of the physical plant. The facility is licensed for six (6) non-ambulatory residents and an approved hospice waiver for six (6) residents; prefers to serve elderly age 60 and above. The one story residential house consists of six (6) resident bedrooms, kitchen, dining area, living room, three (3) residents bathrooms, staff quarter (located in the back of the house), garage, washer/dryer located in garage, and backyard with a shaded patio, front landscape and yard was well maintained at time of visit. During the tour, LPA observed the facility’s infection control practices. LPA was properly screened for Covid-19 symptoms, temperature was checked. LPA observed a sanitizing station at the facility entrance; a visitors log with Covid-19 screening protocols, PPE supplies are readily available with an additional 30 day supply of PPE in stock. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has outside visitation area located in the shaded backyard, and inside visitation available as well. LPA observed all staff wearing face coverings. LPA observed required postings throughout the facility. CCLD PINs were readily available to staff and residents. All rooms were inspected, bedrooms are private, one resident per room. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Resident bathrooms were checked, sufficient liquid soap and towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew. The water temperature measured at 114.9 F in bathroom one (1) and 115.3 F in bathroom two (2). Comfortable temperature of 69.4 was maintained in the facility. LPA toured the kitchen area and observed a two-day supply of perishable and a seven day supply of non-perishable food. Knives and toxins were locked. Centrally stored medications were observed stored in their originally received containers and kept safe, locked and inaccessible to residents in care. The facility has two (2) Fire Extinguishers, which were checked and found to be fully charged and accessible. The First Aid kits were available and fully stocked. There are no security bars or weapons on the premises. Outside grounds were toured, and no bodies of water were observed. Common areas were clean and clear of hazards; one doorway from Room D were blocked by chair. No bodies of water present. One deficiency was cited during this visit, see LIC809-D. An exit interview was conducted, and a copy of this report LIC809, LIC809C and LIC809D were provided to facility representative, Joy Black (CA1).