Routine inspection·February 27, 2024

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA arrived unannounced and met with Administrator, Vilma Bohanan, and explained the purpose for the visit. The fire clearance is approved for (6) non-ambulatory residents, ages 60 and over, of which (1) may be bedridden. There is a hospice waiver approved for 4 residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting daily. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. The facility has the sufficient amount for liability insurance covering injury to residents and guests. Physical Plant & Environment Safety: The facility has a swimming pool in the backyard and is surrounded by a locked gate. There are 4 resident bedrooms downstairs, 1 staff room upstairs, 2 communal bathrooms, open living room, dining room, and kitchen. There is a detached garage with a rest area for staff. Facility has an operable smoke detector in each room and a carbon monoxide detector located in the hallway. Knives, cleaning solutions, and disinfectants are locked, making them inaccessible to residents. There are no firearms or weapons stored at the facility. The hot water temperature was measured within the required range of 105-120 degrees F. The fireplace is secured by a fence. Staffing : Per Administrator, she had submitted documents to renew her certificate. LPA verified documents were received and is pending approval. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records-Training : Staff files are maintained at the facility. Staff have current CPR/first aid certificates. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Physician's Report, Pre-admission appraisal, and Resident rights. However, Resident #4, who has dementia, does not have an updated physician's report. Resident Rights-Information: The Complaint poster, Local Ombudsman, and Residents personal rights are posted. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food are properly stored in the refrigerator. Incidental Medical & Dental: The medications are centrally stored and in their original containers. During the visit today, LPA reviewed all 5 residents' medication and they are being administered as prescribed by the physician. Disaster Preparedness: Facility has an updated Emergency Disaster Plan with contact numbers, at least 2 relocation sites, and emergency procedures. Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The staff received training to care for residents with dementia and those on hospice. Deficiencies are issued on the LIC809D form. Technical advisories were also provided. An exit interview was held. A copy of this report, technical advisory notes, and appeal rights were given to the Administrator.