Routine inspection·January 20, 2023

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Haven's House of Assisted Living for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Administrator, April Thomas, and was granted access into the facility. During the inspection process, LPA observed a resident with Dementia based on review of the LIC 602. However, the facility is only licensed to serve residents that are elderly (See LIC 9102). Administrator will contact the Centralized Applications Bureau Unit and then submit a Dementia Program Plan of Operation to the LPA assigned to the facility. LPA and Administrator toured the facility. LPA observed the facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to have no tag. Administrator indicated that they will be getting a new fire extinguisher today (See LIC 9102). All smoke detectors and carbon monoxide detectors were tested and found to be operational during the inspection. First Aid kit was inspected and found to be appropriate during the inspection. Water temperature in 2 of 2 residents bathroom measured at 116 degrees, within acceptable range of 105 to 120 degrees F. Water temperature in the staff bathroom also measured at 115 degrees and is within acceptable range of 105 to 120 degrees. There was sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Cleaning products and other toxins are located in the laundry room that was locked and inaccessible to residents in care. There was a supply of Linens, cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in resident’s rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of all residents bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. (Report continued on LIC 809C) LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE which is stored in the hallway closet closest to the bedrooms. Administrator has not been N95 Fit tested, and will be in the process of obtaining N95 Fit testing. LPA requested the following documents to be sent by January 27, 2023: Dementia Program Plan of Operation LIC 500- Personnel Report LIC 308- Designation of Responsibility LIC 309- Administrative Organization LIC 400- Affidavit regarding Client Cash Resources Updated facility sketch Updated Emergency Disaster Plan (LIC 610D) Surety Bond Most up-to-date Liability insurance Control of Property Register of residents No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator.