Routine inspection·May 21, 2025

At 8:50 am on 05/21/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to conduct an annual facility inspection. LPA met with Licensee/Administrator Hanileta Keohen and Lead Staff (S1), announced who he was and the reason for the visit. At 10:10am LPA and S1 conducted a tour of the facility. This facility has three dual occupancy resident bedrooms and two full bathrooms (one is on-suite and one is for shared/public use). There is a living room with dining space, a kitchen and office area. LPA observed at least 2 - days of perishable and at least 7 - days of nonperishable foods. LPA observed a fire extinguisher near the kitchen that was tagged current and in the green compression range, serviced on 11/16/2024. At 10:15am LPA noted 3 spray cans of primer accessible to residents in care in the kitchen/office area under the medication refrigerator. The living room and dining room have seating to accommodate all residents in care. The living room has a piano for residents to play freely. The resident bedrooms are furnished and space provided for each resident to keep their personal effects. LPA noted the facility is in good repair with no obstructions in hallways, doorways or exits. The facility has battery operated smoke detectors in each room that are all working, the carbon monoxide detector is the dining room and functioning normally. In the shared bathroom LPA tested facility hot water at 112.5*(f), within regulation temperatures 105*-120* (f). Access to the laundry room and garage is through a locked door for resident safety. At 10:40am LPA noted a partial wall constructed of wood panels in the garage. S1 stated staff rest/sleep overnight in the area partitioned off with the wood panels. LPA observed this area is not noted on the facility sketch. (Continued LIC809-C) LPA toured the exterior of the facility noting a large backyard with seating and shade for residents and visitors to enjoy. At 11:01am while touring the backyard LPA noted two cans of paint, various chemicals including round-up and insect repellent, a hand saw and set of large pruning shears not locked up, accessible to residents in care. Medications are locked in a cabinet in the kitchen/office area. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA conducted a staff and resident file review. Resident file review revealed 1 of 4 residents are at risk if they have access to poisonous substances, this resident has an ambulatory status. LPA, Licensee/Administrator and S1 conducted a review of the annual care tool modules. Exit interview, deficiencies cited on LIC809-D pages, report signed, appeal rights, and report provided