Routine inspection·June 16, 2023

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Grace Home Tavel Residential Facility for the Elderly unannounced to conduct an Annual Inspection. LPA rang doorbell and was greeted by staff at the door. LPA introduced self and stated purpose of the visit. LPA was granted entry and asked to sign in the Visitors Log. Staff notified Administrator, Jennifer Hanh of LPA visit and met with LPA at the door. Administrator then accompanied LPA during inspection. LPA conducted a tour of the facility, both inside and outside, and observed the following: Facility: LPA was informed the current census is four (4) at time of visit. The facility is licensed for six (6) residents. Two (2) ambulatory residents and four (4) bedridden residents. There is a Hospice Waiver in place. The facility is approved for 4 Hospice residents. LPA observed that the facility is operating in the capacity and conditions approved by Community Care Licensing (CCL). Physical Plant: LPA observed the facility's temperatures to be comfortable. Water temperature was measured at 118.0 degrees Fahrenheit. Showers and toilets are functional. Each bathroom equipped with grab bars and sufficient paper and hand hygiene supplies. Linens and hygiene items observed are sufficient for the number of residents in care. Each resident room is equipped with regulated furniture, lamps that provide appropriate lighting for residents comfort and safety. The facility is equipped with operational smoke alarms and carbon monoxide detectors. Fully charged fire extinguishers - last inspected June 2022. LPA reviewed the facility's Emergency Disaster Plan and Fire Drills and observed that the facility conducts quarterly Fire/Earthquake Drills - last drill took place in February of 2023. Food Service: Nonperishable and perishable food is sufficient for number of residents in care. Food is being prepared and stored properly. Facility has a variety of food available for residents according to the posted food menu. LPA observed staff preparing lunch for residents. Care & Supervision : Facility has sufficient care staff as regulated. Toxic and sharp items are kept inaccessible to residents in care and stored and locked in a cabinet adjacent to the kitchen. Record Review and Resident/Staff Files: LPA reviewed records for two (2) residents currently residing at the facility. Resident records are complete with updated Physician Reports and Needs and Services Plans. LPA also reviewed staff files and confirmed that staff records reflect current CPR/First Aid Certification and Criminal Record Clearance. The Administrator's Administrator Certificate is in good standing. Administration: Disaster/Evacuation Plan, Long Term Care Ombudsman Poster, Administrator Certificate, Resident Personal Rights, and facility license are posted in a common area in the Facility. Emergency Disaster Plan is current. Medication/Medical Related Services: LPA observed that the residents' medication is centrally stored and locked in a file cabinet near the staff office. LPA reviewed all the residents' medications and compared it to the facility's Medication Administration Report (MARs) and Centrally Stored Medication Log. No medication errors observed. Based on today's inspection, no deficiencies were observed. Exit interview conducted and copy of this report was provided to Administrator/Licensee Jennifer Hanh