Post-licensing visit·September 3, 2024

Unannounced Post Licensing visit made out to this facility on 09/03/2024 by Licensing Program Analyst (LPA) Kesha Lewis. This LPA was met by the facility staff and explained the reason for the visit. Current census was 4 residents. It was learned that there weren't any residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (2) residents under the care of hospice at any given time. It was learned that this facility has a program to be able to accept and retain dementia residents at any given time. Tour of this facility was conducted. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Linen closet, located in facility hallway closet, was reviewed and observed to contain a sufficient supply of towels, sheets, and bedding able to meet the needs of the residents at this time. Kitchen area was toured. Kitchen drawers and cabinets were opened and reviewed. Food supply for 2-day perishable and 7-day nonperishable quantities was reviewed to make sure that they were in compliance at all times. Pantry area was toured. Additional food storage units located in the garage area were observed to be present and functional at this time. Laundry area, located in the room next to the garage, was toured. Bleach, detergent, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Medication cabinets, located in the facility living area, was observed to be locked and made inaccessible to the residents at this time. First aid kit, located in the kitchen cabinet, was reviewed. Fire extinguishers were located throughout this facility and observed to have been purchased at the local store, with the receipt with date of annual purchase attached on 10/23/2023, and in compliance at this time. Facility resident bedrooms were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Facility resident restrooms were toured. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. A tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and all other exits was conducted. A review of (0) facility personnel records was conducted on the LIC 859. A review of (3) facility resident records was conducted on the LIC 858. The following forms and documents were requested to be updated and submitted into CCL for review by this LPA: by 9/13/2024. LIC 308 LIC 400 LIC 500 LIC 610 There are deficiencies being cited during today's post licensing visit. Exit Interview and copy of report given.