Routine inspection·July 11, 2025

Licensing Program Analyst (LPA) De Leon arrived at 9:45am to conducted a 1 year annual visit to the facility above. LPA met Administrator Todd Tose and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted Infection Control Plan. The facility has a sign in and out binder for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety: The facility is has 21 bedrooms and bathrooms and 2 bedrooms with a shared bathroom, and 1 common area restroom. The facility currently has 21 residents and employs 23 staff and 1 Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has a carbon monoxide detector, smoke alarm and sprinkler system. The lighting and lamps are sufficient for the use of the facility and for residents comfort. The facility kitchen has a tap with hot water and warning sign is posted. The showers have non-skid textured floors. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The facility has a signal system in each residents room. The pathways are clear of any obstructions, well lit and equipped with hand railings where needed on ramps and porches. Fire places has screened coverings. Disinfectant, cleaning solutions and poisons are inaccessible to clients in care. The facility has sufficient space inside and outside for activities and visiting. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 02/01/2026. The facility is approved for a capacity of 32 Non-Ambulatory and has a current Hospice wavier granted for 6. Staffing: The facility employes 23 staff and 1 Administrator. Staff records are kept confidential. Staff records were reviewed for 5 staff and 1 Administrators. Staff records had finger print clearance and associations with criminal record statements, personnel record or applications, First Aid and CPR certificates and Health screening with TB results. Facility employs sufficient and competent staffing for resident care, cooking, housekeeping, office work and maintenance of building and grounds. The facility has sufficient night staff on duty. Staff are trained to effectively interact with emergency personnel and provide residents medical records to emergency responders. Administrator Certificate is valid. Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed 5 staff training records which were current for 2024-25 initial /or annual training requirements. Staff have been fingerprinted with criminal record clearances or exemptions. Administrator meets continuing education requirements for renewal of administrator certificate. Trainers meet the education and experience requirements. Staff training documents have trainers name, address, phone numbers, topic or subject matters, times, dates and hours. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Five files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Pre-Admission appraisals are conducted on perspective residents before excepting them into care. The Facility does not handle cash resources for any resident in care. Facility does submit incident reports to the department when required. Resident Rights Information: All require postings were posted in the common area of the facility. Personal rights, Rights to Resident Council, Theft and Loss policy, and Non-discrimination notice. CCL Complaint poster and LTCO poster were posted in the common areas of facility. The current license along with CCL reports and PIN's were posted. Visitation policy is posted at entry. Continued 809-C Planned Activities: The facility offers activities to all residents in care. The facility employs an Activities Director and a monthly calendar with all activities is posted. The facility also offers additional activities to include books, magazines, newspapers, television, daily walks, group discussions and communications, games and puzzles. The facility has a piano for resident use and musicians come to entertain residents. The facility has sufficient space to allow for activities indoors and outdoors as well as an activity room. Food Service: The facility employs food service staff. The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. A menu is posted for residents in care. Modified diets prescribed by a physician are followed for those residents in care. Cleaning solutions and equipment are stored separately than food supply. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical & Dental: Facility provides transportation to medical and dental appointments when needed. The medications records were reviewed for the Centrally Stored Medication and Destruct Records (CSMDR) and Medication Administrator Records (MAR). LPA completed a full audit on all residents medication, all medications were in original containers, prescription labels were not altered, and no medications was expired. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers were charged and last inspected 07/31/2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does not accept dementia residents in care. The facility does not have delayed egress. The facility does have residents with oxygen and required signs are posted. The facility has hospice residents in care. Hospice care plans are kept on file and up to date. The facility does currently have residents on Home Health services and plans are kept up to date. LPA conducted interviews with 4 Residents and 1 staff. Exit interview conducted and copy of report printed for Administrator.