Post-licensing visit·May 15, 2024

On 05/15/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a post- licensing visit utilizing the care tool. LPA met with Administrator, Lina Tuiloma and explained the purpose of the visit. The facility was licensed on/around 12/29/23 for six (6) non-ambulatory residents and has an approved hospice waiver for one (1). Currently, there are five (5) residents and no one receiving hospice services. LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but not limited to: two (2) private resident bedrooms, two (2) shared residents bedrooms, two (2) bathrooms, laundry room, kitchen, backyard and the common areas. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Toxins, knives and medications are locked and inaccessible to residents in care. Hot water temperature was measured at 116 degrees Fahrenheit at the kitchen sink, which is within the required range of 105 to 120 degrees. The temperature in the facility was 72 degrees. LPA observed fire detectors and carbon monoxide detectors to be operable. LPA observed required Licensing posters posted throughout the facility. LPA conducted a file review of two (2) resident files. Residents files contain signed admission agreements, physician reports, Identification sheets, releases, preplacement appraisals, and resident rights. LPA also conducted a file review of two (2) staff files. Staff have training in dementia, first aid and CPR, and other various areas of care provision. As a result of today's inspection, no deficiencies cited. Exit interview conducted and a copy of the report was left at the facility.