Routine inspection·November 5, 2021

On 11/05/2021, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with House Manager Gel Culala and explained the purpose of today’s visit. The facility is licensed to operate for six (6) elderly residents ages 60 and above. The facility is approved for four (4) non ambulatory and two (2) bedridden of which four (4) can be under hospice care. The facility is a single-story structure located in a residential neighborhood. The facility consists of the following: five (5) resident's rooms, three (3) bathrooms, a living room area, two (2) dining areas, kitchen and an attached garage used for storage only. The laundry area is adjacent to the kitchen and there is a second refrigerator/freezer in the garage. LPA and House Manager toured the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature of 74 degrees was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, and toxins were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. There is one (1) fire extinguisher fully charged in the dining room area. First aid kit was available. Smoke detectors and carbon monoxide were operable. A review of Medication Administration Records (MAR) was maintained in order and accurate. Evaluation Report Continues on LIC 809-C. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed six (6) clients and two (2) staff present during the tour. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. Advisory Notes – Three (3) Technical Assistance were issued, please see LIC9102-AN. Two deficiencies were cited during this inspection visit. See 9099-D page. An exit interview was conducted and a copy of this report was provided to Licensee Heidi Skiles.