Post-licensing visit·May 16, 2024

On 05/16/24 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, Christine Chua- Harris and explained the purpose of the visit. The facility was licensed on/around 02/13/24 for six (6) non-ambulatory residents and has an approved hospice waiver for four (4). Currently, there are six (6) 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: resident bedrooms, bathrooms, kitchen, garage, and backyard. 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 117.2 degrees Fahrenheit at the kitchen sink, which is within the required range of 105 to 120 degrees. The temperature in the facility was 74 degrees. Fire extinguisher was last inspected on 11/06/23. 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 and one (1) staff file. LPA observed one (1) staff working at the facility who is not fingerprint cleared. Administrator stated they will send staff today to get fingerprinted. LPA additionally provided facility with LIC311f which states required documents for personnel and resident files. LPA completed the full care tool, deficiencies was observed and civil penalties was assessed. Please see LIC 809-D. Exit interview conducted and a copy of the report and appeal rights was provided.