Routine inspection·April 19, 2023

Licensing Program Analyst (LPA) Javina George conducted an unannounced annual/1 year required visit on 04/19/2023 at 10:30am. LPA was granted entry by Caregiver Evita Chow, who was informed of the purpose of the visit. The Administrator Levi Faddoul arrived shortly after. The facility is a single story home with (3) bedrooms and (2) bathrooms designated for the residents and there is one (1) bedroom and one (1) bathroom available for staff to use. LPA conducted a tour of the interior and exterior of the facility and observed the following: Infection Control: The LPA observed the hand washing stations in the bathrooms. LPA also observed gloves at the facility and sharps container for needles. Physical Plant: LPA observed the clients bedrooms which contained the required furniture and personal rights postings. The interior and the exterior were observed to be clean, odor and clutter free. floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair. The facility does not have a pool or any other bodies of water on the premises. The water temperature was tested and was found to be within regulatory limits 109.2-115.9 degrees Fahrenheit. Food Service: LPA observed the kitchen to be clean and possess equipment in good working condition. LPA observed the facility had the required 2-day perishable and 7-day non-perishable food supplies. The sharp and dangerous objects are kept locked in the kitchen in a drawer in a black tool box next to the refrigerator and or stove. Care & Supervision / Administration: Adequate staff are present for the supervision of residents. At the time of LPA's visit there were two (2) observed caregivers for the six (6) residents in care. Emergency exiting plans, emergency telephone numbers and personal rights were found posted in the facility on the wall inside of the dining area. Record Review and Resident/Staff Files: LPA observed staff had current CPR/First Aid Certification. The six (6) resident files were also found to be completed with the required Physician reports (LIC 602), and appraisals there is one resident that has their appointment on 4/27/23 to get their updated 602. Additionally, LPA conducted (2) staff and (3) resident interviews. The staff were able to answer the questions with some additional clarification. Incidental Medical: LPA reviewed the medications for (3) residents and found that all resident medications were accounted for, with proper labeling, and medication administration log was found to be accurate and up to date. Disaster Preparedness : The facility has record of conducted emergency drills (earthquake, fire, flood). Per Administrator Levi, the drills are conducted on a quarterly basis and the last drill was on 1/1/23, and it was a fire drill. The facility's fire alarms (4) and(1) carbon monoxide detectors were tested and are operable. LPA observed there to be one fire extinguisher on the premises located in the dining area. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Levi Faddoul.