Routine inspection·December 6, 2024

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit for a required annual inspection . The LPA was greeted by the House Manager Dawn Jensen notified them of the purpose for the visit and was allowed to enter the facility to conduct the inspection. Facility Overview: The facility is two- stories building with four(4) residents bedrooms, 1 staff bedroom and 3 bathrooms. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in a kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPA observed fire extinguishers to be in compliance with the department requirements and with an expiration date of 09/18/2025. LPA observed the hot water temperature to meet requirements at 111.2°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of February 5th, 2025 and a CPR certification with the expiration date of 11-28-25 Record Review and Resident/Staff Files: LPA reviewed files for Three(3) staff members, confirming criminal clearances, and CPR/First Aid certification. A fourth staff member personal file was no available for LPA to review. A citation will be issued. Five (5) residents' files were reviewed and contained all required documentation. LPA observed first aid kit, Staff and resident files to be stored in a locked cabinet in the hallway. Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the hallway. LPA reviewed medications for six(6) residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 10-1-2024, which met department requirements. All facility exits were clear of obstructions. An exit interview was conducted, during which this report was reviewed, and a copy was provided to house manager Dawn Jensen along with the appeal rights