Routine inspection·January 23, 2025

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection, and met with Administrator (ADM) James Equing . License, Personal Rights posters, and Administrator Certificate were observed at entrance. LPA observed 4 staff and 6 residents in the facility. LPA reviewed 3 residents files (R1 - R3) and 3 staff files (S1 - S3). 2 Out of 3 residents (R1 and R3) centrally stored medication forms were observed not matching with their medication counts. LPA toured the facility with ADM inside and out. LPA inspected living room, kitchen, dining area, 2 sitting areas, and laundry room. There are 6 single rooms for residents, and one staff live-in room in facility. 3 bathrooms were inspected. Two days perishable foods and seven nonperishable foods were observed sufficient. The temperature of the refrigerator was observed at 16 degree F, and the temperature of the freezer was observed at -1 degree F. Room temperature was observed at 72 degree F. Hot water was observed at 117 degree F. Medication cabinet, and knife closet, were observed locked. Dish washing solution bottle was observed on the top of sink in the kitchen, ADM locked the dish washing solution bottle in the closet under the sink immediately. ADM stated staff just finished using the dish washing solution after lunch. LPA checked the call bell system in resident rooms and it was functional. Door alarms were observed installed at the exit doors. First Aid box, flash lights, and night lights were observed in the facility. LPA observed 6 beds in the resident rooms with half bed rails. ADM provided 6 residents' physician reports. 1 Out 6 residents is on hospice care, and 5 Out of 6 residents having physician orders for using half bed rail. Continue on LIC809-C. The facility's last time conducted the fire drill was on 1/7/2025. Front yard and back yard were inspected. LPA observed a tree's branches blocked half of the walkway to the exit. Staff trimmed the tree branches before LPA completed the visit. No obstruction was observed to block the walkway after staff had trimmed the tree.. Deficiency noted today. See LIC809-D. Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.