Routine inspection·May 18, 2024

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today. The last annual conducted at this facility was on 05/26/2023. When the LPA arrived, there were two (2) staff and four (4) residents present. LPA met with staff and the reason for the visit was explained. The Licensee Representative arrived at 9:30 a.m. Entrance interview. At 9:31 a.m., the LPA along with the Licensee Representative toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 9:46 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates. The knives and sharps were observed locked and inaccessible to residents in care. At 9:49 a.m., the hot water temperature was measured in the kitchen sink, and it measured 112.2 degrees Fahrenheit. COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. At 9:51 a.m., the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 07/12/2024. LPA observed required postings throughout the common space. There is a working telephone on premises. Activities for resident use were observed in the living room. Continued on LIC 809C... Continued from LIC 809... GARAGE: The garage is attached and was inaccessible to residents in care at the time of the visit. There is one (1) additional refrigerator with perishable foods in good condition. A small locked mini refrigerator was observed with resident’s medications inaccessible to residents in care. The facility has a sufficient amount of emergency food and water. Washer and dryer were observed in the garage. Detergents and cleaning solutions were observed inside locked cabinets at the time of the visit. BACKYARD: The backyard has a shaded area with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There were two (2) gates with self-latching mechanisms. No bodies of water were noted at the time of the visit. BEDROOMS: There are four (4) resident bedrooms and one (1) staff bedroom. Two (2) bedrooms are double occupancy, and two (2) bedrooms are single occupancy. LPA observed the resident bedrooms to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. A closet in the hallway was observed with additional clean linens and towels for resident use. A locked closet in the hallway was observed with residents’ personal hygiene items inaccessible to residents in care. RESTROOMS: There are two (2) restrooms for resident use. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. Hand washing signs were observed posted in the restrooms. The hot water temperature was measured in both bathrooms; the first bathroom measured 114 degrees Fahrenheit at 9:32 a.m.; and the second bathroom measured 112.8 degrees Fahrenheit at 9:39 a.m. RECORDS: Records review began at 10:05 a.m.; four (4) resident records were reviewed for, but not limited to: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. All resident records were complete. Continued on LIC 809C... Continued from LIC 809C... Two (2) personnel records and Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Personnel files were complete. Administrator’s Certificate is current and valid until 06/30/2025. During today’s inspection, LPA obtained copies of Personnel Report LIC 500, Client/Resident Roster LIC 9020, and Emergency Disaster Plan LIC 610E. The Licensee Representative will be emailing copy of liability insurance to LPA no later than Monday 05/20/2024. The last disaster drill was conducted on 04/26/2024. MEDICATIONS: Medications review began at approximately 1:30 p.m.; medications are centrally stored and locked in a cabinet by the living room. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications are properly documented on the centrally stored medications and destruction record. Medications appeared to be given as prescribed at the time of the visit. Exit interview conducted. No citations issued at this time. Report was reviewed and a copy was provided.