Routine inspection·June 19, 2025

Licensing Program Analyst (LPA) De Leon arrived at 9:30 am to conduct a 1 year annual visit to the facility above. LPA met with Administrator Nikole Daugherty 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 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 disinfectant spray and cleaners. The facility has a 30-day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environment Safety : LPA toured 10 residents room and on suite bathrooms. The fire extinguisher were charged and tagged on 07/31/2024. The facility has 15 resident bedrooms with on suite bathrooms, and 1 common area restroom. LPA was authorized to enter and inspect facility. The facility has dual smoke and carbon monoxide detectors. 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 or textured bottoms. 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 stored in locked storage rooms. The facility has sufficient space inside and outside for activities and visiting. The facility has a patio with furniture, walkways and shaded areas for resident use. The facility is completely fenced with pull up gate latches that are self closing and self latching. 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 06/16/2026. The facility is approved for a capacity of 16. The fire clearance is granted for 16 non-Ambulatory, 16 of which may be bedridden. Hospice is approved for 12. Staffing: The facility currently employes 23 staff, and 3 Administrators. Staff records are kept confidential. Five staff files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and fingerprint clearance or exemptions. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have annual training completed for 20 plus hours from 06/2024-06/2025. 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 5 resident files for signed Admission Agreements, Safeguard for property and valuables, LIC. 602A Physicians report, Appraisals Needs and Services Plan, and Emergency and ID forms. 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. Cleaning solutions and equipment are stored separately from food supplies. The facility has an emergency food and water supply. Continued 809-C Incidental Medical Services: Facility provides assistance in arranging 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 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 conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. Keys and Codes are available for staff on all shifts to access full facility in an emergency. Disaster plan reviewed and is signed off annually by Administrator. Residents with Special Health Needs: The facility does accept dementia residents in care, all sharps, knives, cleaning products and items that can pose a hazard are locked in storage rooms. The facility currently does not have any residents oxygen. The facility does not have any current residents on hospice services. The facility currently has 2 residents on home health services. Hospice and Home Health Plans are kept up to date and on file at the facility. Exit interview conducted and copy of report printed for Administrator.