Routine inspection·April 3, 2024

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 9:15AM to conduct an Annual Required inspection and was greeted by staff. LPA and staff discussed the purpose of the visit. Back up Administrator, Shella Pastor arrived shortly after. LPA and Administrator initiated a tour of the facility around 09:45 AM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in sinks accessible to clients measured at 112 and 113 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinets containing cleaning supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods which were of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water is stored in hallway closet. Personal Protective Equipment is stored in the garage. Fire extinguishers were last serviced May 17, 2023. Facility has combination smoke and carbon monoxide detectors located throughout the facility that were tested and operational during inspection. Facility is equipped with fire doors on all doors. Most recent fire/disaster drill was conducted 01/14/2024. Client cash resources were reviewed. Facility was over the limit listed on their LIC400 (Affidavit Regarding Client Cash Resources). LPA and Administrator discussed that they must update their LIC400 and their Surety Bond in order to handle a larger sum of cash. Continued on LIC809C Continued from LIC809 Five staff files and three resident files were reviewed. Staff have required First Aid and CPR certificates. Medications and medication records were reviewed. Administrator Certificate for Administrator, Shella Pastor (6060239740) is up to date and expires 07/07/2025. No deficiencies cited during inspection. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on forms confirms receipt of documents. LPA is requesting the following documents to be submitted to Community Care Licensing by 05/03/2024: LIC 500 Personnel Report LIC 9020 Resident Roster LIC 308 Designation of facility responsibility Updated LIC 400 Affidavit Regarding Client Cash Resources Updated Surety Bond