Routine inspection·October 16, 2024

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and met with Henry Cole, Administrator, explaining the purpose of the inspection. The facility is licensed for (142) residents, (127) of whom may be non-ambulatory and (12) of whom may be bedridden. Currently there are (41) residents in the Memory Care Unit, (42) residents in the Assisted Living and (28) in Independent Living Unit. There are (11) residents under hospice care currently. LPA and Administrator toured the interior of the Assisted Living Unit (ALU), including the common areas, main kitchen, activities room, gym, salon, library and medication room. The separate Memory Care Unit (MCU) was also toured where many activities were observed. In all areas toured, there were no health and safety concerns. LPA observed 2+day perishable food and 7+day non-perishable food in the main kitchen. The facility also has an emergency supply of food. Freezer/refrigerator temperatures are checked daily. Specific resident diets are posted also in the main kitchen and weekly menus are posted in common areas. Hot water temperature was checked in (2) ALU resident rooms and in (2) MCU resident rooms- all readings were 116*F. There are fire extinguishers throughout that were last serviced 6/19/24. All required postings are in the common areas. Administrator's RCFE Certificate #7028142740- exp 5/23/26 was posted. LPA reviewed (11) resident files - (5) from ALU and (6) from MCU. All files were complete and contain current physician's reports/care plans. Medications were reviewed for (2) ALU residents and for (1) MCU resident. Medications are being administered correctly per orders and electronic documentation is current. (7) staff files were reviewed. All staff are cleared/associated and have completed initial/ongoing training as required and have current First Aid/CPR certifications on file. Facility vehicle records show weekly and monthly checks are completed. LPA requested an updated copy of LIC308 and current liability insurance be emailed by 10/23/24. LPA obtained a copy of October staffing schedule. There are no deficiencies issued during today's inspection. Exit interview. Copy of report provided to the Administrator.