Routine inspection·April 12, 2022

On 04/12/2022 at 1:00 PM, Licensing Program Analysts (LPAs) T. White and R. Campbell arrived unannounced to conduct a required 1-year annual inspection. LPAs met with Administrator, Priscilla Quipevis and explained the purpose of today’s inspection. LPAs were allowed entry into the facility that is licensed to serve a total capacity of 24 non-ambulatory residents, which 6 may be on hospice. LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 110 and 120 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. LPAs observed smoke detectors is interconnected with the fire department. Carbon monoxide was in operating condition during inspection. Fire extinguisher was last serviced on December 13, 2021. LPAs observed completed mitigation plan. LPAs reviewed 5 resident files and 5 staff record files. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 004/22/2022: LIC 308 Designation of Administrative Responsibility LIC 500 Personnel Report LIC 610 Emergency Disaster Plan No deficiencies cited during inspection. Exit interview conducted with Administrator and a copy of report given.