Routine inspection·January 28, 2025

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:00AM. The LPA was greeted by staff, Facility Designee Karina Antig arrived shortly thereafter and LPA informed them of the reason for the visit. Beginning at 10:13AM, the LPA and Facility Designee 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. The following was observed: Combination smoke and carbon monoxide detectors were tested at 10:47AM and were operational at the time of the visit. The two (2) fire extinguishers were fully charged and last serviced 05/14/2024. KITCHEN: Knives and cleaning supplies are stored in locked cabinets inaccessible to residents at risk. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. COMMON AREAS : At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature throughout the visit. The LPA observed required postings throughout the common space. BEDROOMS: There are 5 (five) designated resident rooms and 1 (one) staff room. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are available as needed. LPA discussed with Facility Designee following up with the Fire Inspector related to a requested change in status from non-ambulatory to bedridden. Continued on LIC 809-C BATHROOMS: The facility contains 2 (two) resident bathrooms; 1 (one) is a common restroom and the other is a private resident restroom. Both restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with soap and paper towels and available hygiene products. The hot water temperature in the hallway bathroom measured within the required range. OUTDOOR AREA/GARAGE: The backyard has an outdoor area equipped with furniture and shade for resident use. There is a side gate for resident exit and is single latched. No bodies of water noted. The garage contains an additional refrigerator and freezer with perishable food items. Additional nonperishable food was observed along with emergency food and water. Cleaning supplies and disinfectants are stored in the locked garage. The laundry area is located in the locked garage. All laundry supplies are locked and inaccessible to residents in care. RECORDS: Records will be reviewed during the annual continuation visit. MEDICATIONS: Medications are stored locked in a cabinet in the eating area adjacent to the kitchen. First aid kit was observed to be complete. Medications will be reviewed during the annual continuation visit. INFECTION CONTROL/EMERGENCY DISASTER PLAN: Will be reviewed during the annual continuation visit. INTERVIEWS: During today's visit, LPA interviewed 2 (two) residents. No concerns were noted. Additional interviews will be conducted during the annual continuation visit. Due to time constraints, LPA will return at a later date to continue the annual inspection. No citations issued. Exit interview conducted. A copy of the report was provided to Facility Designee.