Routine inspection·October 1, 2024

On October 1, 2024 at Licensing Program Analyst (LPA) De Anna Williams-Lyons arrived unannounced to conducted an Annual Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lyons met with Ola Samuels, Licensee, who assisted LPA in today’s inspection. The Administrator certificate expires 12/13/2024. The current census is 4 The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 67 degrees F. This is a one story home with 4 bedrooms and 3 bathrooms. LPA inspected the interior and the exterior of the facility including the common living spaces, the resident bedrooms and bathrooms and kitchen. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. Hot water temperatures were taken and measured at 105 degrees F. There’s appropriate lighting throughout the home. Living rooms, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident bedrooms and bathrooms were toured. There are 4 Bedrooms. All rooms had the required items of furniture. Window screens were on and in good repair. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. The sink, toilet, bathtub and shower operate properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care. Washer and dryer was present and operating properly. Toxic substances, laundry and cleaning supplies were inaccessible. To continue see 809-C... First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguishers are maintained and ready for emergency use. LPA inspected the exterior grounds of this facility. LPA toured the exterior grounds. There are no bodies of water on the premises. The perimeter fence, side gates, and latches were in good repair. Passageways are free of obstruction and potential hazards There’s a drawer for resident’s medication. Medication cabinet was locked. The facility Medication Administration Record was reviewed as well as the dispensing log. All current and up to date. LPA reviewed 2 resident files and 1 staff files. Resident's Records reviewed indicated emergency contacts, Assessments, Admission Agreements and Physician's Reports were all current and up to date. Staff records reviewed revealed current First Aid & CPR certificates, Health Screenings, Emergency Contacts, Criminal Record Clearances were all up to date and the facility is conducting staff training as required . File review reveals all documents are in the regional facility file. LPA and Ola conducted the Inspection Tool with no issues or concerns. The facility has had 2 residents with Covid-19 since the last annual inspection. The licensee is following her Infection Control Plan as required. In the areas that were evaluated, no deficiencies were observed. The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file. Administrator shall submit the listed documents to Licensing no later than November 1, 2024. Licensee submitted the document at this visit, An exit interview was conducted and a copy of this report was given to Ola.