Routine inspection·July 20, 2023

Licensing Program Analyst (LPA) Jenny Olson arrived at the facility unannounced to conduct a required annual visit at 10:15 a.m. When LPA arrived, there were three staff and five residents present. LPA was greeted by Administrator and informed them of the reason for the visit. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives are stored in a locked drawer in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Common areas: Living and dining room furniture were observed to be in good condition. At around 12:30 p.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. There is a fireplace in the living room, which is screened and inaccessible. LPA observed required postings throughout the common space. The fire extinguisher was charged and serviced 3/16/2023. The backyard has a covered outdoor area equipped with furniture for client use. No bodies of water noted. The washer and dryer are in the kitchen. Restrooms: The two resident restrooms were clean and sanitary and in operating condition with non-skid mats. The bathrooms were sufficiently stocked with soap and paper towels. Around 3:20 p.m., the hot water temperature measured in the kitchen at 116.7 degrees Fahrenheit. Bedrooms: There are four (4) resident rooms, which were furnished. A linen closet was located outside of the rooms, which stocked extra linens and towels. Records: LPA reviewed resident and staff records around 10:30 a.m. LPA reviewed five (5) resident files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, and current needs and services plan. Residents Medical assessments and needs and services plan were not current. Continued on 809-C LPA reviewed four (4) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. All files were complete. MEDICATIONS: Medications review began around 1:00 p.m. The medications are centrally stored and locked in a cabinet in the family room. Medications are labeled and checked for expiration dates. LPA advised the Administrator to ensure that all the necessary information is properly documented on the CSMAR. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. At 3:30 p.m., LPA interviewed two (2) staff members and two (2) residents. During today’s visit, the LPA obtained copies of the following: staff and resident roster and current liability insurance. Exit interview conducted. A copy of the report was provided.