Routine inspection·June 11, 2024

Licensing Program Analysts (LPA) Kesha Lewis and Licensing Program Manager (LPM) Liza King arrived at this facility unannounced to conduct a Required 1 Year Annual Inspection Visit. LPA and LPM were met by administrator. LPM explained the purpose of the visit to Administrator. LPA ,LPM and health and well-ness director inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 56 bed facility with a current census of 42. There is entry door is leading to the living room, kitchen with a hallway to the bedrooms and bathrooms. Chemicals and medications noted to be locked to residents in care. LPA pushed the call button in room five (5) the was no response from facility staff. LPA and also conducted the care tool. No bodies of water were observed at the facility. Hot water temperature was measured at 107 F degrees Fahrenheit in residents bathroom sink, which is within the required range of 105 to 120 degrees Fahrenheit. The average temperature was 107 F. LPA observed the following posted on the facility wall: Facility license, sketch, See Something Say Something poster, Ombudsman poster, Theft and Loss Policy, Resident Bill of Rights, Rights of Resident/Family Councils. The facility submitted a LIC 808 mitigation plan, which was approved. LPA observed the facility to have adequate food supply of 7 days non-perishables and 2 days perishables in place. Resident rooms were sanitary and had the required furniture and furnishings. The signal systems in room five (5) was pushed by LPA and there was no response by facility staff. when Well-ness director checked the alert was not sent to care staff beepers. The maintenance director states the the call system is tested monthly by randomly choosing about six (6) rooms. LPA observed, fire extinguishers inspected on 10/07/2023 the fixed system was inspected 04/17/24 there are current, smoke and carbon monoxide detectors, central heating and air in the facility. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. Last fire drill was conducted on 06/10/2024 for NOC shift and 05/30/2024 for day shift. LPA reviewed two (15) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPM reviewed two (9) resident facility files, COVID-19 Plan, and survey binder. All necessary documents were in place. Deficiencies are being cited during today visit see 809D page.... Exit interview held with staff and copies of reports and appeal rights left at conclusion of visit.