Routine inspection·December 7, 2022

Licensing Program Analyst (LPA) Wendy Gibb conducted an unannounced required annual visit with a primary focus on Infection Control measures using the CARE Inspection Tools. LPA met with Tracy Moore and explained the purpose of this visit. The facility is licensed for 6 non-ambulatory residents and 3 hospice approved waivers. Currently, all 6 residents are over the age of 60, there are 5 non-ambulatory, and 1 ambulatory resident, with two in hospice care residing in the facility. Structure The one story residential house consists of (3) resident bedrooms, (2) resident bathrooms, living room, dining room, kitchen,(1) staff bedroom, (1) staff bathroom, and (1) den/office. Physical Plant Outside grounds were toured, and no bodies of water were observed. There is an outside seating area in the back that has an umbrella for shade, and a table. Walkways around the home were clear of obstructions, and debris. Bedrooms All rooms were inspected. Beds in shared bedrooms are 6 feet apart/3 feet head-to-toe apart. Bedrooms had all the required furniture including, beds, dressers, nightstands and chair. All rooms had ample lighting and closet space for all residents. Beds had the required linens, mattress pad, fitted sheets, blanket, comforter and pillows. Linens & Hygiene LPA observed ample supply of linens in the hall closet with include blankets, sheets and towels. There were additional comforters in resident’s closets. LPA observed an ample supply of hygiene product and personal need item (diapers, mats) Bathroom Resident bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew, and a non-skid mat was in place and a shower chair. The water temperature measured at 112.2 degrees F. Common rooms Common areas were clean and clear of hazards; doorways were free of obstructions. A comfortable temperature was maintained in the facility. In the living room and dining room there is ample seating for all residents and lighting. LPA observed games and other activities for residents. Kitchen LPA toured the kitchen area and observed a three-day supply of perishable and a seven-day supply of non-perishable food. All appliances were in good working order. All cutleries were in good condition. Knives and toxins were kept in a locked cabinet and inaccessible to residents. Water temperature measured 114.3 degrees Fahrenheit. Files LPA reviewed all resident files and found they contained all the necessary documentation. LPA reviewed all staff files and found they contained all the necessary documentation. Medications LPA reviewed all resident medications and matched them to the MARs. All centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to Residents in care. Safety The First Aid kit was inspected and found to contain the required items including the manual. One (1) Carbon Monoxide and five (5) Smoke Detectors (connected) were working properly. All alert systems are working properly. The facility (1) Fire Extinguisher was checked and found to be fully charged, accessible, and last serviced on 03/29/2022 . All required safety posting were observed. Infection Control During the tour, LPA observed the facility’s infection control practices. LPA was properly screened for Covid-19 symptoms and temperature was checked upon arrival. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log, and records of daily Covid-19 screening and temperature checks of residents and staff. All visitors must show a negative Covid-19 test, if they have not been tested the facility will provide visitor with a test. PPE supplies are readily available to staff, and an additional 30-day supply of PPE was observed. Sufficient paper, cleaning, and disinfecting supplies were observed. All staff were wearing a face covering. LPA observed required postings throughout the facility. LPA reviewed the Liability Insurance which expires on 5/31/2023. LPA verified that the facility has an approved mitigation plan report. An exit interview was conducted, and a copy of this report was provided to Administrator Tracy Moore.