Routine inspection·October 27, 2023

Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection. LPA Rodgers was granted entry into the facility by Executive Director, Bonghabih Shey Smith, after identifying herself and stating the purpose of the inspection. The facility serves 60 non-ambulatory residents, age 60 and above, of which 15 may be bedridden, and currently has 41 residents in care. There is an approved Hospice Waiver for 20 residents. This is a one-story complex, comprised of four (4) wings and equipped with fully secured perimeters. LPA was accompanied by the Executive Director Shey Smith, during a tour of the facility, which was conducted inside and out and included a sample of resident units, the dining area, recreation rooms, and food storage areas. There is a fire signal system in place and the carbon monoxide detectors were operational. The last disaster drill was conducted on October 2023. There is a water fountain located outside the entrance of the facility and made inaccessible with rocks filling the large pool of water at the base of the fountain. Exterior and interior passageways were free from obstructions. According to Executive Director Shey Smith, there are no weapons and/or ammunition stored on the premises. Pull cords were available in each resident units that were tested for functionality. Resident's room temperatures were within a comfortable range. Continued on 809-C Continued on 809 Each resident had clean and sufficient bed linens, towels, and washcloths. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars, and nonskid strips were present in residents’ showers. Community showers was clean and in working order. Hot water temperature in residents’ bathrooms were compliant. Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closets. The medication room is secured and has a locked medication cart, medications were labeled and kept in compliance with label instructions. LPAs interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained all required documents. LPA Rodgers also conducted a thorough review of In-service training procedures. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. An exit interview was conducted and a copy of this report and Licensee/Appeal Rights - LIC 9058 (rev. 01/16) were provided to the Executive Director Shey Smith, whose signature on this form acknowledges receipt of these documents.