Routine inspection·August 29, 2023

On 8/29/2023, Licensing Program Analyst (LPA) Janette Romero arrived unannounced at the facility to conduct an annual required visit. LPA was greeted and granted entry by Caregiver Deborah Johnston who was informed of the purpose of visit. During the visit, there was three (3) residents and one (1) staff present, and LPA was informed two (2) residents were out in the community. The facility is approved to care for six (6) non-ambulatory residents and has a hospice waiver for two (2). LPA toured the facility's interior and exterior. During the visit, LPA observed the following: Kitchen: LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. The facility had a 2-day supply of perishable food items and 7-day supply of non-perishable food items. Knives/sharp instruments are secured in a locked kitchen cabinet. Dining and Living room: LPA toured the dining and living/family room area. LPA observed area to be clean and furniture in good condition. A fire extinguisher was charged and mounted in the living room. Hallway : LPA observed hallway to be clean with no pathway obstruction. Carbon monoxide and smoke detector were tested and functioning properly. Continued on LIC809-C.. Centrally Stored Medications: LPA observed a first aid kit with required components. Medications were secured in a cabinet near the kitchen. LPA reviewed physical medications for the Resident #1 and Resident #2 as well as the Medication Administration Record (MAR) used to log administration of residents’ medications. LPA found that Staff #1 dispensed medication for all residents this morning (8/29/2023) and did not document assistance with medication on MAR. Deficiency cited. Bedrooms : Resident bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting. Bathrooms: Bathrooms have a working toilet, wash basin, and were equipped with a grab bar in the shower. The hot water temperature measured at 117- and 118-degrees Fahrenheit. The facility has clean towels, blankets, and linen, available in different colors for the residents in care. Laundry/Garage : LPA observed laundry room and garage to be clean. Washing machine and dryer are in good repair. Cleaning solutions and chemicals are secured in locked garage cabinet. Emergency food supplies, water, and incontinent supplies are stored in the garage. Records: Staff #1 (S1) present has a criminal record clearance on file and is associated to the facility. S1's CPR/First Aid certification expired on 4/27/2023. Deficiency cited. Yard/Outside Area: Covered patio seating is available for residents. A vinyl fence secured the entire backyard. All outdoor pathways were free of obstructions. No bodies of water were observed. There were no firearms or ammunition observed at the facility, and LPA was informed the facility will not store firearms or ammunition on the premises. LPA did not observed two (2) deficiencies faulting the facility. An exit interview was conducted, and a copy of this report was reviewed and provided to Caregiver Johnston along with an LIC809-D and Appeals Rights.