Routine inspection·July 6, 2022

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required visit. LPA met with caregiver Maedna Arbis and explained the reason for the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident files. The facility is a single story house and located in a residential neighborhood area. The facility consists of living room, kitchen, dining room, two residents' bathrooms, four residents' bedrooms, staff bathroom, laundry room and a detached garage. All four residents bedroom were toured. Bedroom#1 has one bed, one chair, one drawer, required linen and furniture and sufficient lighting and closet space. Bedroom#2 to #4 has two beds, two drawers, required linen and furniture and sufficient lighting and closet space. All two residents bathrooms were toured and they are clean, sanitary and in a good condition. Bathrooms also have required grab bars and non-skid mats. The hot water temperature tested at the two residents bathrooms were between 133.1 and 138.0 which is beyond the required 105-120 degrees F. The refrigerator in the kitchen and garage and kitchen cabinet has sufficient food for two days perishable and seven days non-perishable. All the kitchen appliances are working properly. The knives and utensils are locked in the kitchen cabinet. The common areas such as living room and dining room are clean and have required furniture. All the cleaning supplies and chemicals are locked in the cabinet in the laundry room which is inaccessible for residents. The front and back yard are maintained well and the back yard has a shaded area and sitting area for residents to utilize. All the carbon monoxide detectors and smoke detectors are inspected and they are working well. LPA reviewed 6 resident files to confirm emergency contact is updated. LPA was not able to review any staff file because there's no staff files were located in the facility. LPA reviewed 6 residents' medications. All medication are centrally stored and all residents medication seems adequate and up-to-date. Facility is currently following COVID 19 recommendations regarding COVID 19 signs throughout the facility, disinfecting products are available in each room and common area and facility is disinfected every shift and once a month for deep cleaning. The bathrooms have sufficient soap, paper towels, and signs. The PPE supplies are sufficient for more than 30 days. The deficiencies cited are documented on the attached 809D. A copy of the report and appeal rights will be provided to caregiver