Routine inspection·October 6, 2023

Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility for the purpose of an annual review. LPA was greeted by Administrator, Eric Melad and explained the purpose of the visit. A tour of the facility was conducted inside and out. At the time of visit, all three residents were home and one additional staff was present. The facility is approved for six (6) elderly residents ages 60 and over all of whom may be non-ambulatory. There is a hospice waiver for two (2) residents. The facility is a four (4) bedroom two (2) bathroom one story home. Each residents have their own bedroom. The fourth bedroom is reserved for staff. During the tour the following was observed: Resident bedrooms had the required furnishings and were observed to be in good condition. Bathrooms had required signage, hand rails, non-slip mats. 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 residents. Hot water was tested at 134 degrees Fahrenheit which is above the maximum temperature of 120 degrees Fahrenheit. Administrator adjusted the hot water temperature and will contine to monitor the temperature, adjusting it accordingly. 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. Area was observed to be clean and functional. Care & Supervision : Facility has sufficient care staff employed. Administration: Emergency exiting plans, telephone numbers and Ombudsman information and other required signage are posted throughout the facility. Drills are conducted regularly. The last drill was 3/20/2023. 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. The Administrator's certificate expires 10/21/2023. Resident records were reviewed and the following deficiency was observed: -File review for R1 did not contain a current Physician's Report. The last Physician report was completed in 2020. LPA informed Administrator Physician's reports must be updated annually. Citation issued. Physician reports for all other residents are current. All other documents in residents files were up to date. Medication Review: LPA reviewed medication and medication log. Residents' medications are being dispensed according to physician's orders. LPA provided a copy of the LIC 809, LIC 809D, and appeal rights to Administrator, Eric Melad during the exit interview.