Routine inspection·March 27, 2023

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, James Reed who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (5) residents present. The facility is a one story home with (3) bedrooms and (2) bathrooms. The clients served are eldery age 60 and up, with a hospice waiver for (6). LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted staff and resident interviews. LPA observed the following: Infection Control: The LPA observed the hand washing stations in the facility restrooms. LPA observed gloves and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures. LPA observed a 30 day supply of PPE at the facility. Physical Plant: LPA observed the resident bedrooms. Physical plant, floors, windows, and doors were observed to be clean and in good repair. Fixtures and furniture were in good repair and were present. The outdoor area was observed to be free of hazards. Laundry room was observed to be locked and was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to residents. During the walk through LPA spoke with the staff and administrator who stated they use master restroom as a guest restroom for visits and caregivers. LPA observed (2) residents currently reside in the bedroom. LPA observed curtains that were placed in the restroom. The facility will receive a type A violation for this. Plan of correction was documented for this. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision / Administration: Adequate staff are present for the supervision of residents. Emergency exiting plans, telephone numbers and personal rights were found posted in the facility. The listed administrator, possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed (2) staff files and reviewed the facility's staff schedule. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Two (2) resident files were reviewed, and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All resident medication was locked in a medication cabinet and locked garage refrigerator. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA observed all facility exits were clear from obstructions. LPA observed emergency food supply in the facility garage along with emergency flashlights. An exit interview was conducted where a copy of this report along with LIC 809-D page, and appeal rights were provided to Administrator, James Reed.