Routine inspection·January 17, 2023

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on the infection control domain, food and medication review. LPA Flores met with Denise Sutton Administrator and explain the reason of the visit. The facility is licensed to serve 60 non-ambulatory residents over the age of 60, of which 5 residents may be bedridden and has a hospice waiver for 9 residents. The facility is located in a residential area and consist of a multi level building with a dining room, library area, a commercial kitchen, courtyard, and patio. LPA Flores conducted a tour of the facility with Denise Sutton administrator and observed the following: Kitchen area is clean, refrigerator and pantry were observed with sufficient food for at least 2 days of perishables and 7 days of non- perishables. Resident's room #119,123,203,205,224,228,231,232 were observed each room is private with a private bathroom and has the required furniture, sufficient lighting, and are in good repair. Bathrooms have skid mats, grab bars, and are in good repair. Water temperature was tested in each bathroom observed and it tested between 116.7 and 121.4 degrees F., which is not within the required 105-120 degrees F. Library, activity area in second floor, staff lounges, laundry are were observed in good repair. Hallway to the left of the elevator in the 2nd floor around rooms #224 and #204 had a missing ceiling piece due to water damage which was observed in the ceiling above and in water makr was observed in the carpet. Per administrator water damage occurred after the rain. Facility has a contract dated 1/10/23 with roofing company for repairs to begin by 1/20/23. Signs are posted in the lobby and social distancing signs throughout the facility. Additional symptoms and precaution signs were not observed throughout. LPA review medication and files for 4 residents, and 4 staff files. Administrator certificate # 6009562740 expiration date 3/5/23 was observed and a copy of liability insurance was requested. Deficiency has been noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Denise Sutton Administrator and a copy of this report, LIC 809D, and appeal rights were provided.