Routine inspection·March 27, 2025

Licensing Program Analyst (LPA) Rankin arrived at 9:08 am to conduct a 1-year annual visit to the facility above. LPA met with Administrator Designee Desiree Verry and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The bathrooms have toilet paper, paper towels, and hand soap. The facility has EPA approved disinfectant spray and cleaners. The facility has a 30-day supply of PPE. Physical Plant & Environment Safety: The fire extinguisher was last purchased on March 10, 2025. The facility has 4 resident bedrooms, 2 bathrooms currently occupying 4 residents. The facility has smoke and carbon monoxide detectors that were tested and working at the time of the visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats. The main pathways are clear of any obstructions. Resident room with cognitive resident has some items in the exit pathway, facility is working with resident to fine suitable containers and will move to a safe location. Facility is well lit inside and outside for safety. Disinfectant and cleaning solutions are inaccessible to residents in care and stored/locked in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on July 11, 2025. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-Ambulatory. Hospice is approved for 2. Staffing and Training Records: The facility currently employs 3 full time staff, 1 part time staff and 2 administrators. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements. Administrator file was reviewed and Administrator Certificate expires April 10, 2025. Staff have annual training completed for various subjects/topics and hours for 2024. Resident Records & Incident Reports: The facility keeps separate files on each resident confidential. Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible, and records are kept confidential. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7 day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides transportation or assist in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility last conducted a quarterly disaster drill March of 2025. Emergency exits and telephone numbers were posted. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 2 self-latching gates on side of the home. The facility does have 1 resident currently on hospice. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report, was printed for Administrator.