Routine inspection (multi-day)·June 17, 2024

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Case Management - Annual Continuation visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with General Manager Karl Miller. The facility is licensed for a maximum capacity of 200 residents, 75 of which may be non-ambulatory. The facility has a waiver for 7 hospice residents. During today’s visit, the facility had a census of 164 residents. The Administrator for the facility is Jessica Sommer and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected a random sampling of resident rooms, common bathrooms, facility kitchen, common areas, and outside space. LPA observed a water fountain near the facility entrance that held approximately 5 inches of standing water and was not fenced, covered or made inaccessible to residents. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured in a random sampling of resident bathrooms and common bathrooms at 119.5, 118.0, 118.5, 117.7, and 105.6 degrees Fahrenheit. The facility’s internal temperature was measured at 75 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Karl Miller, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and label. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 35 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance and were associated to the facility. Continued on LIC809-C page… LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property, and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. The General Manager will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. The following deficiency was cited for an accessible body of water and noted on the attached LIC809-D page. Additionally, a civil penalty in the amount of $500 was assessed for an accessible body of water and noted on the attached LIC421IM form. An exit interview was conducted with General Manager Karl Miller, whose signature below confirms receipt of a copy of this report, LIC421IM, and the Licensee Appeal Rights (LIC9058 3/22).