Routine inspection·November 21, 2024

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced at 09:32AM to conduct an annual inspection. LPA was greeted by staff. The LPA communicated with the Administrator/Licensee Cilva Toume via telephone and explained the reason for the visit. Licensee Cilva Toume arrived at 10:12AM. Entrance interview conducted. Beginning at 10:26AM, the LPA along with the Licensee 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: BEDROOMS: The facility contains 6 (six) private residents’ bedrooms and 2 (two) staff bedrooms. Every residents’ room has a direct exit to the outdoors. Staff rooms remain locked. All resident rooms were observed to contain appropriate furnishings, linens and lighting. RESTROOMS: Facility has one common bathroom and private bathrooms in room #1 and #5. Bathroom s are equipped with grab bars and non-skid mats in the shower area for resident use. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in the common resident restroom and measured within the required range after a slight adjustment. COMMON AREAS: The living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is not in operation and is blocked by the television cabinet and the television. The facility maintained a comfortable temperature throughout the visit. Hardwired smoke and carbon monoxide detectors were tested and were operational. One fire extinguisher was fully charged and purchased on 05/23/2024. The LPA observed required postings by the entrance of the facility. KITCHEN : Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Report Continued on LIC 809-C OUTDOOR AREA/GARAGE: The backyard has an outdoor area equipped with furniture for resident use. There is a side gate for resident use which is single-latched. No bodies of water were noted. Passageway was clear and free of hazards. The garage is attached to the home and was observed to be locked. The washer and dryer are located inside the garage. Cleaning supplies were located inside the garage and the staff rooms were observed as part of the converted garage, which Licensee indicated is permitted. RECORDS: Records review began at 11:25AM. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Residents and staff recorsd are kept in a locked dining area cabinet. MEDICATIONS: Medications review began at 01:36PM. Medications are centrally stored and locked in a cabinet in the dining area; medications are labeled and checked for expiration dates. LPA reviewed medications for 2 (two) residents. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and Emergency Disaster Plan. Both documents were observed to be complete and updated annually as required. Emergency drills are conducted quarterly, with the last drill conducted in September 2024. INTERVIEWS: Throughout the visit, LPA interviewed staff and residents. No concerns were noted during the interviews. No deficiencies cited. Exit interview conducted. A copy of the report was provided.