Routine inspection·June 21, 2021

Licensing Program Analysts (LPAs) Sarah Hurt and Jason Lund conducted an unannounced visit today to revise the annual inspection that was conducted previously on June 14,2021. LPAs met with Madison Mayol. There were currently 8 residents at this time. There weren't any residents on hospice at this time. LPAs inspected the interior and the exterior of the facility. A tour of the common living spaces, resident bedrooms and bathrooms were conducted. In addition, a tour of the activity rooms, medication storage, and kitchen are was conducted. A tour of the garage and outdoor areas was conducted. Resident bedrooms were observed to be clean and in good repair at this time. There was a locked storage for medications which was observed to be inaccessible to the residents at this tine. Food supply was adequate for 2-day perishable and 7-day nonperishable quantities. Fire extinguishers were set to expire on 10/09/2021 and observed to be in compliance at this time. Smoke alarms were tested and were operational. This facility home had a carbon monoxide detector and observed to in compliance at this time. Water temperatures were tested and was measured to be at 108.9 F degrees. First Aid kit was on site and did contain all required components. Toxins were observed to be locked and made inaccessible to the residents at this time. This facility was operating within the scope of their license at time. LPAs reviewed 2 resident files. Resident files and medications were reviewed. All resident files reviewed were in compliance. Three staff files were reviewed and observed to be in compliance at this time. First Aid and CPR training was current and staff training was observed to be in compliance at this time. No deficiencies were observed and cited during todays annual inspection. The administrator shall send in updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-D the Emergency Disaster Plan if needed and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. On Monday June 14, 2021 LPA'S Charlie Yang and Sarah Hurt conducted the annual inspection and documented on wrong facility. Exit interview conducted with Administrator and copy of report left at facility.