Routine inspection·August 16, 2024

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced required annual inspection visit and was greeted by Administrator Gregg Knapp. LPA Ramirez explained the purpose of the visit. The facility is located on a residential street and is a single store dwelling. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be accessible to residents in private bathroom#2, located in resident bedroom#3. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected four (4) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observe postings encouraging proper handwashing etiquette in restrooms. LPA Ramirez observed grab bars near toilets and inside showers. LPA Ramirez observed no-slip mat in showers. Showers were observed to be wheelchair accessible. Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40 degree F. (4 degree C). Planned Activities: LPA Ramirez observed puzzles, blocks, memory games and coloring books in living room area. Residents Rights-Information: LPA Ramirez observed the following posting in common area of the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Last documented emergency drills were conducted on 03/06/24. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. See 809-D Residents with Special Needs : No large bodies of water were observed. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices and delay egress perimeters were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored facility cabinet. LPA Ramirez observed three (3) containers of medication sitting on top of kitchen counter and accessible to residents and visitors. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA Ramirez observed six (6) out of the six (6) residents MAR did not reflect documentation of continuing medication care administered from 8/14/24 through 8/16/24 (AM only). The facility provides incidental medical services. LPA Ramirez observed six (6) out of the six (6) residents had their medications transferred from their original container and into a 7-day pill box organizer. Staffing: Administrator Certificate for Gregg Knapp expires 06/16/2025. 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. LPA Ramirez observed required annual training, CPR and First Aid for two (2) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance for three (3) out of the three (3) personnel records reviewed. LPA Ramirez did not observe job applications for three(3) out of the three (3) personnel records reviewed. Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for six (6) non-ambulatory. This facility may retain no more than three (3) hospice residents. There are three (3) residents under hospice care. Resident Records/Incident Reports: LPA reviewed Resident files for six (6) residents. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed for five (5) out of the six (6) residents in care. R2 did not have signed Admission Agreement, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, and Resident Rights. Some information was missing on these forms. Deficiencies were observed today. Exit interview was conducted. A copy of this report, 809-D, LIC 9120 and appeals rights was provided.