Routine inspection·October 10, 2023

Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility for the purpose of an annual review. LPA met with Brenna Tomlinson, Administrator and explained the purpose of the visit. A tour of the facility was conducted inside and out. At the time of visit, there were six (6) residents home and one (1) staff present. The facility is a six (6) bedroom four (4) bathroom one story home. Each resident has a private room. During the tour the following was observed: Residents bedrooms had the required furnishings and were observed to be in good condition. Bathrooms had required hand rails, non-slip mats, hand washing signage and personal toiletries. Night-lights were observed in the hallways. Fixtures and furniture for an operational facility are present and in good repair. All passageways were free of obstructions, charged fire extinguishers and the fire alarm system was operable, medications are kept centralized and locked, hazardous items are kept inaccessible clients. Hot water was tested at 15.7 degrees Fahrenheit. Backyard area is free from obstructions. Kitchen/Food Service: LPA observed the entire kitchen, food is stored properly and dishes are clean and in good condition. There is a sufficient supply of perishable and non-perishable foods. LPA observed fresh fruit and vegetables in the refrigerator. During the inspection of the kitchen and dining area, LPA observed ants and cockroaches in some of the kitchen cabinets and on the dining room floor. Administrator stated the facility has been receiving pest control services specifically for the above mentioned pests since September 2023. LPA was also informed that the facility has been receiving pest control services in general since March of 2022. LPA was provided the last six month copies of invoices from a pest control service. Continue on LIC 809C.... Care & Supervision : Facility has sufficient care staff employed. LPA interviewed one staff member. Administration: Emergency exiting plans, telephone numbers and Ombudsman information and other required signage are posted throughout the facility. Drills are conducted monthly. The last drill was conducted in August 2023. The Administrator's certificate expires on 9/22/2024. Record Review and Client/Staff Files: LPA reviewed current staff and all staff have has Criminal Background Clearance, current CPR/First Aid certification, and trainings are current. Upon review of client records, the following deficiency was observed: -LPA observed three out of six resident resident files reviewed did not have current Physician Reports. Medication Review: LPA reviewed medication and medication log. Residents' medications are being dispensed according to physician's orders however upon audit of medications the following deficiency was observed: -LPA observed medications for all clients were prepared in advanced and stored in medication cups. LPA informed Administrator this was against regulations. Deficiencies were cited in the above references. A copy of this report along with LIC 809D, LIC 811 and Appeals Rights were provided to Administrator Brenna Tomlinson.