Routine inspection·May 4, 2023

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and met with Administrator, John Schoonover. LPA initiated a tour of the facility around 12:40pm and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Water temperature in bathroom used by residents measured at 107 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinet containing cleaning supplies was locked. Knives are locked in kitchen drawer. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Emergency food and water supplies are stored in the garage. Fire extinguisher is fully charged and is due for servicing as of 4/2023. Administrator will replace Fire Extinguisher. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational during inspection. Three staff files and three resident files were reviewed. Administrator Certificate for Administrator, John Schoonover 6030504740 expired 2/2/2023. Administrator provided proof that they have sent in the documents for recertification to the Administrator Certification Unit. Medications and medication records were reviewed. Continued on LIC809C Continued from LIC809 Licensee/Administrator to submit updates of the following documents by 6/04/2023: LIC 500 Personnel Summary LIC9020 Register of Facility Clients/Residents Copy of Liability Insurance LIC 610 Emergency Disaster Plan (If changes) Infection Control Plan (If changes) No deficiencies cited during this inspection