Routine inspection·November 12, 2021

Licensing Program Analyst (LPA) Anthony Tuck arrived to conduct an unannounced annual/random inspection on 11/12/2021. LPA met with title: Maria Cleiotilde Brelin and explained the purpose of the visit. Maria Cleotilde Brelin is the Administrator and holds certificate #6041889740 that expires on 07/17/2022. This facility is a single story building licensed to serve six (6) non-ambulatory residents of which 1 resident may be bed ridden and a hospice waiver for 6 residents. LPA toured the physical plant including but not limited to two resident bedrooms, two resident bathrooms, garage and backyard area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed a body of water at the facility to be safely locked and secured with a gated fence around the pool. Vehicle transport was inspected fro safety. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at (109.4) degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher last serviced 01/20/2021. Thermostat observed at 76 degrees Fahrenheit. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed staff associations to the facility. First aid kit was checked and is complete. The following forms need updating and were collected during today's visit on 11/12/2021: LIC 308, LIC 500, LIC 610E, LIC 9020, Admin Certificate, Liability Insurance Certificate No deficiencies were found during today's visit. Exit interview held with Maria Cleotilde Brelin and a copy of report given at the conclusion of the visit.