Routine inspection·April 3, 2024

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection to the above-named facility. LPA was greeted by Staff 1 (S1). LPA explained the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) and is home to non-ambulatory residents with a dementia diagnosis. There are no residents on hospice at this time. Entrance interview conducted: At the time of the arrival, there were two (2) staff on duty and five (5) residents in care. LPA met with Administrator Trina Dellinger throughout the inspection. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the facility for fire safety, personal accommodations, and food service. The physical environment was checked for cleanliness and condition. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Cleaning agents and the kitchen trash can are kept in a locked cabinet under the kitchen sink. The living room and dining area are neat and clean. The facility has five (5) bedrooms for a capacity of six residents. Bedroom #5 is a shared bedroom with two residents. All of the bedrooms are furnished with lights and nightstand lamps to provide sufficient lighting. There are two bathrooms in the facility available for use to all residents. At approximately 11:20 AM, LPA observed Bedroom #4 has a foul odor. Advisory Notes - Technical Assistance issued. There is one private bedroom for staff behind the kitchen and laundry area. The facility maintains a comfortable room temperature. Please continue to 809-C, Pg 2. LPA determined there is a sufficient amount of food consisting of two (2) days of perishables and seven (7) days of non-perishables. Snacks and beverages are available for Residents upon request. The backyard has a covered patio with outdoor furniture and a locked shed. The front yard and backyard have seating areas, potted plants, and paved walkways conducive for outdoor visitations. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Residents records were reviewed for Physician’s reports, health screenings, pre-appraisals, re-appraisals, reporting requirements, and centrally stored medications. Due to time restraints, LPA will return at a later date to continue the inspection. Exit interview conducted. Advisory Notes - Technical Assistance issued. Copy of report issued at the time of the visit.