Routine inspection·May 22, 2023

On 05/22/23, Licensing Program Analyst (LPA) Wendy Gibb conducted an unannounced required annual visit using the CARE Inspection Tools. LPA met with Administrator, Tracy Moore and explained the purpose of this visit. The facility is licensed for 6 non-ambulatory residents and 3 hospice approved waivers. Currently, there are six (6) residents over the age of 60, there is one (1) ambulatory and five (5) non-ambulatory residents, with three (3) on hospice care residing in the facility. Structure The facility is a single-story home in a residential neighborhood. The facility consists of three (3) resident bedrooms, one (1) resident bathroom, living room, dining room, kitchen, staff room, staff bathroom, and staff office. Physical Plant LPA Gibbs and Administrator Moore toured the facility inside and outside. LPA observed a patio with seating area with table, chair, and umbrella available for Resident use. All walkways were observed to be clean, clear, and free of debris, hazards, and obstructions. LPA did not observe any bodies of water on the premises. All gates exiting the facility are easy to open and are accessible. Bedrooms LPA inspected all three (3) bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, nightstands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting. Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid mat and shower chair. Resident’s toiletries are secured in a cabinet under the sink. The water temperature measured 110.7-degrees Fahrenheit. The Staff bathroom was observed to be clean. The toilet and faucets are operational. Both bathrooms were observed to be clean, in good repair and within Title 22 regulations. Continued on LIC809-C Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blank, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in the hall closets. LPA observed incontinence care products stored in the resident’s closets and in the hall closet. LPA observed an extra supply of hygiene products secured in a cabinet in the laundry room. Kitchen/Laundry Room LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, washer, dryer, refrigerator, and additional freezer. LPA observed an ample supply of cutleries, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked drawers in the kitchen and are inaccessible to residents. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. All foods and condiments were labeled with the date when they were opened and date of when they expire. All food was properly stored and labeled. Cleaning products and toxins were secured in a locked cabinet above the washer and dryer and are inaccessible to residents. The water temperature measured 108.7-degrees Fahrenheit. Common Rooms In the living room, LPA observed, ample seating for all residents and space to accommodate resident’s wheelchairs. At the time of visit three (3) residents were participating in daily exercise from their chairs and recliner. In the dining room, LPA observed a rectangle table and chairs to accommodate all residents. Some chairs have been moved out to accommodate wheelchairs. LPA observed some residents coloring and doing other activities. LPA observed books, games, crafts, and activities for residents. LPA observed all walkways and hallways to be clear, clean, and free of obstructions and hazards. LPA observed ample lighting is all rooms. The facility is maintained at a comfortable temperature. Safety LPA observed and tested smoke/carbon monoxide detectors to be fully operable. LPA observed an additional Carbon Monoxide detector in the hallway. LPA observed a fully charged fire extinguisher mounted on the wall in the kitchen, last serviced on 03/29/23. The last emergency drill was conducted on 04/20/23. LPA inspected the First Aid kit and found it contained an ample supply of required items and a manual. LPA observed the required posting in the facility. LPA observed all exits to be clear and easily accessible. There are no firearms or ammunition stored on the premises. Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked cabinet in the kitchen. LPA reviewed all Resident’s medications and matched them to the MARs. LPA observed all narcotics to be secured in a locked box inside the locked medication cabinet. Files LPA reviewed six (6) resident files and found the contained all the necessary documentation. LPA reviewed six (6) staff files and found they contained the required documentation, certification, and training (20 hours annually conducted through Relias and assistedlivingeducation.com and in-service trainings). LPA reviewed and obtained copies of Client Roster, Staff Roster, Emergency and Disaster Plan (LIC610E), Activity Schedule, Meal Menu, Plan of Operation, Liability Insurance, and Admission Packet with Advertising. Liability Insurance expires on 02/24/2024. Infection Control During the visit, 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. Visitors are required to show a negative Covid-19 test. If they do not have proof of negative test, facility will test visitors before entering the facility. 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. Interviews LPA conducted three (3) staff interviews. All staff were able to explain policy, procedures, and resident’s personal rights. LPA conducted four (4) resident interviews. All residents interviewed said they were well fed, happy and received services required. LPA did not observe any deficiencies during the time of visit. An exit interview was conducted with Administrator Tracy Moore and a copy of this report was provided.