Routine inspection·February 14, 2024

Licensing Program Analyst (LPA) Miller arrived at 10:02 a.m. to conduct a one-year annual visit to the facility above. LPA met with Administrator Edwin Ingan 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: Physical Plant & Environment Safety: The facility has 3 resident bedrooms, and 2 bathrooms. Facility currently occupies 5 residents and employs 6 full time staff and one Administrator. LPA Miller was authorized to enter and inspect facility. The facility had a smoke and carbon monoxide detector that was tested and working properly during visit. The fire extinguisher was last inspected on January 5, 2024. 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 pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked in cabinet in the garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use and front patio has plenty of shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on October 28, 2024. The facility is approved for a capacity of six. The fire clearance is granted for 6 non-Ambulatory of which one may be bedridden. Hospice is approved for three. Continued on 809-C Staffing: The facility currently employes 6 full time staff, and one Administrator. Staff files were reviewed. Current Administrator Certificate expires November 22, 2024. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours for 2023. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed five resident files for signed Admission Agreements, medical assessments and appraisal & needs service plans. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, 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. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Disaster Preparedness: The current emergency disaster forms were posted. 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 accept dementia residents in care. The facility currently has two residents receiving Home Health services and one resident is on hospice. Exit door alarms are working. Exit interview conducted, copy of report provided.