Routine inspection·November 20, 2024

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 01:48PM. LPA was greeted by facility staff upon arrival. Licensee/Administrator Christine (Tina) Rowe was contacted via telephone and arrived at 02:08PM. Entrance interview conducted. Facility is a single-story residence that consists of five (5) resident bedrooms and three (3) bathrooms. The LPA observed (1) fully charged fire extinguisher and last serviced on 06/21/2024. All hardwired smoke alarms and separate carbon monoxide detector were tested at 04:23PM and functioned properly during time of visit. LPA observed all required postings in the entrance of the home. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Beginning at 02:13PM, the LPA along with Licensee conducted a tour of the physical plant to ensure there are no health and safety hazards and the facility is in compliance with Title 22 regulation. The following was observed: KITCHEN : The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked box in a drawer to the left of the stove. GARAGE: The locked garage is where the washer and dryer are held. The garage also contains additional non-perishable emergency food and water, storage and personal care supplies. Cleaning supplies and disinfectants are stored in locked cabinets in the locked garage. SURROUNDING GROUNDS (OUTDOORS) : There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. The side gate was observed to be self-closing and latching. All exits were clear and free of hazards. Report Continued on LIC 809-C COMMON AREAS: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The facility maintained a comfortable temperature throughout the visit. BEDROOMS: There are 5 (five) resident rooms; 1 (one) is designated as a shared resident room and the remaining 4 (four) are designated for private resident use. The resident bedrooms were properly furnished with at least one chair, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. BATHROOMS: LPA observed all resident bathrooms clean, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in resident bathrooms. Residents have sufficient amounts of supplies for personal hygiene. Water temperature was measured in the shared resident restroom and was 118.1 degrees Fahrenheit, which is within the required range. RECORD REVIEW: Beginning at 02:30PM, LPA reviewed staff and resident files for items including, but not limited to: medical assessments, TB clearance, personal rights, staff training records, health screening and personnel records. The LPA reviewed five (5) resident files and five (5) staff files. All documents, both staff and resident reviewed appeared complete and current. MEDICATION REVIEW: Medications review began at 04:04PM. LPA reviewed medications for 2 (two) residents. Medications are centrally stored and locked in a cabinet in the kitchen area and in a lockbox in the refrigerator. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. EMERGENCY DISASTER PLAN/INFECTION CONTROL PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually, as required. Emergency drills are conducted quarterly, with the last drill documented on 11/06/2024. No citations issued. Exit interview conducted and copy of the report was provided.