Routine inspection·May 16, 2022

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on infection control, medication, and food review. LPA Flores met with Andrei Kohler administrator and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents over the age of 60. Facility serves dementia residents and has a hospice waiver for 4. The facility is single story home located at a residential area and has 4 resident bedrooms, 1 full bathroom and 1 guest bathroom, a living and dining area, kitchen, detached garage, storage shed, a basement, a front yard, and back yard. LPA conducted a tour of the facility with Andrei Kohler administrator and observed the following: Smoke/Carbon Monoxide detectors were observed, tested and are in working condition. Fire extinguisher was observed. Facility has auditory device in exit doors. Living room has a covered fireplace. Sharps and cleaning solutions were observed locked in kitchen drawer and cabinet under sink, hand washing sign, soap, and paper towels were observed by kitchen sink. Perishables were observed sufficient for at least 2 days and non-perishables were observed for at least 7 days. Medication cabinet was observed locked. All bedrooms have sufficient lighting, all required furniture, and bedding. Bathrooms have sufficient soap, paper towels, and hand washing sign. Water temperature was tested in resident bathroom #1 at 120 degrees F., and in guest bathroom #2 at 116.0 degrees F., which is within the required 105-120 degrees F. Facility has 30 day of PPE supplies. LPA reviewed medication and files for 4 residents and 2 staff files. No deficiencies were given under Title 22 Regulations Division 6 Chapter 8. Exit interview was conducted with Andrei Kohler Administrator and a copy of this report was provided.