Routine inspection·December 18, 2024

On 12/18/2024, Licensing Program Analyst (LPA) Cassie arrived unannounced at the facility to conduct a required annual visit utilizing the full care tool. LPA met with caregiver and explained the purpose of the visit. Today's census is five residents in care with no residents on hospice services. Facility is in compliance to licensure. During today's inspection, LPA and Caregiver conducted a tour of the facility to ensure the health and safety of residents in care. Areas toured included but not limited to six private residents bedrooms, three bathrooms, staff room and the common areas. LPA observed the facility to have the mandated posters posted in the common area. LPA observed facility having seven days of non perishables in the pantry, LPA observed toxins to be locked and inaccessible to residents in care. Facility thermostat was set at a comfortable temperature. LPA observed carbon monoxide alarm to be working. LPA observed medication to be pre-poured in a cup set on the kitchen table. LPA was informed it was being prepared for dinner in the next hour. LPA and Caregiver discussed ensuring the emergency exit door is never blockade. LPA conducted file review and observed the required documents present. LPA reviewed facility Emergency Disaster Plan and observed it to be reviewed on 11/14/2024 by Administrator. At this time, LPA is requesting a copy of liability insurance and LIC 500 to be emailed to LPA by December 23, 2024. Care tool was completed and deficiencies cited. Please see LIC 809-D. Exit interview conducted and a copy of the report and appeal rights was provided.