Routine inspection·December 13, 2021

Licensing Program Analyst (LPA) Anthony Tuck arrived to conduct an unannounced annual/random inspection on 12/13/2021. LPA met with Irene Sauseda and explained the purpose of the visit. Irene Sauseda is the Administrator and holds certificate #6021292740 that expires on 11/16/2020. This facility is a single story building licensed to serve eleven (11) residents of which 4 may be ambulatory, 6 may be non ambulatory and 1 bedridden. The facility is approved for a hospice waiver for up to 3 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. There are no bodies of water present. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at (115) 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 11/14/ 2021. Thermostat observed at (72) degrees Fahrenheit. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed resident and staff roster. LPA reviewed staff associations to the facility. First aid kit was checked and is complete. The following forms need updating and were received on 12/13/2021: LIC 308, LIC 500, LIC 610, LIC 9020, Certificate of liability insurance, administrator certificiate No deficiencies were found during today's visit. Exit interview held with Irene Sauseda and a copy of report given at the conclusion of the visit.