Routine inspection·March 19, 2024

Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Tess Derafera. According to the facility’s license, the facility has a maximum capacity of six (6) residents, all of whom may be non-ambulatory and three (3) may be bedridden. There is a hospice waiver for six (6) residents. During today’s inspection, there were a total of six (6) residents in care. LPA, accompanied by Derafera, toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at taps accessible to clients were all compliant. There was at least two (2) days supply of perishable food, and at least seven (7) days non-perishable food present. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters observed available to clients. Medications were labeled, as required, and stored in locked areas. (CONTINUED ON LIC809-C) (CONTINUED FROM LIC809) No pools or bodies of water were observed on the premises. Per Derafera, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. LPA issued two (2) technical violations. An exit interview was conducted with Derafera to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.