Routine inspection·November 9, 2023

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced to conduct an Annual Required inspection and was greeted by staff. LPA met with Caregiver, Gladys Flores. LPA initiated a tour of the facility around 9:20AM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Staff bedroom was locked and inaccessible to clients. Six of six resident beds are equipped with half rails. Physicians reports reflected the need for half rails for mobility. LPA discussed with staff that physician is to fill out the report. Water temperature in bathrooms used by residents measured at 123 and 116 degrees F. Sink closest to water heater was not within the range of 105 to 120 degrees F allowed per regulation. LPA requested water heater be turned down slightly, and staff immediately turned down water heater. Extra hygiene products and linens were available. Cabinets containing cleaning supplies were located in garage and locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Facility has a pool in backyard that is fenced and locked. Emergency food and water supplies are stored in the garage. Facility has extra Personal Protective Equipment upon entry. Fire extinguishers were last serviced August 2023. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational during inspection. Fire/disaster drills are being conducted quarterly with the last one conducted July 2023. Continued on LIC 809-C Continued from LIC 809 Five staff files and five resident files were reviewed. Staff have required First Aid and CPR certificates. Training records were reviewed. Administrative Certificate for Administrator, Elizabeth Allen, 6000978740 expired 10/19/2023. Administrator has sent in all required recertification paperwork. Medications and medication records were reviewed. Administrator to submit updates of the following documents by 12/09/2023: Admission Agreement Personnel Report (LIC 500) Liability Insurance Infection Control Plan (If any changes) Emergency Disaster Plan (If any changes) No deficiencies cited during this inspection. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.