Routine inspection·December 11, 2024

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Patti Fesseha. During the visit, LPA observed 5 residents and 2 staff. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, 2 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 115 degrees F in both resident bathrooms. While touring the home, LPA observed the family room, adjacent to bedroom #4. LPA observed the family room was being used as a bedroom. ADM stated she is having a resident stay there and did not notify the Department of the change of use of this room. (Photographs were taken). While touring the backyard, LPA observed a sliding screen door installed in bedroom #4 and the family room adjacent to bedroom #4. ADM stated stated these changes were done sometime in February 2024. LPA requested to review the facility fire/earthquake drill log. The facility's last drill was on September 31, 2024. LPA observed the fire drill for the fourth quarter had already been signed, for December 31, 2024. ADM stated it was a typo and the drill was conducted in December 1, 2024. LPA requested ADM conduct another drill for the month of December and send LPA documentation that the drill had taken place. Page 1 Out of 2. Fire extinguisher was serviced in February 1, 2024. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit LPA reviewed facility records for 3 residents. Resident R1's physicians report dated June 14, 2022 and May 29, 2024 states R1 has a neurocognitive disorder. A review of R1's needs and services plan, dated February 8, 2023, states R1 has mild dementia. ADM stated she did review R1's May 29, 2024 physicians report. LPA asked to review resident R3's care plan. ADM stated she has not created one. ADM stated she only has the pre-admission appraisal. LPA asked again if she has any documentation of the care plan for R3. ADM stated she has not done it. LPA reviewed 3 staff records. LPA requested to review staff S1 and S2 health screening. ADM stated she has not done the health screenings for these two staff. LPA requested to review S1 and S2 and S3's education background and past experience. ADM stated she knows but has not documented it in the staff's files. LPA requested to review S1, S2 and S3's first aid training. (S2's first aid training is expired.) ADM stated the staff has not completed their first aid, but they are planning on completing the first aid training later this month. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 2 residents. LPA provided ADM with a flyer "Important updates to Dementia Care & Miscellaneous Changes, Effective January 1, 2025." LPA requested a copy of the following documents: 1.LIC 500, Personnel Summary 2.LIC 308, Designation of Administrative Responsibility 3.LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. Qualifications of Administrator (Certificate) 6. Copy of surety bond 7. Please review your facility program for updates (incorporating new laws and/or regulations) Deficiencies cited during today's visit, see LIC809-D. Technical violations were cited. This report was reviewed with Administrator Patti Fesseha and a copy of the signed report was provided. Appeal rights were provided. Page 2 Out of 2. END OF REPORT.