Routine inspection·January 14, 2025

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:05AM. 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 11:40AM, 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: Smoke detectors and carbon monoxide detector were tested at 02:26PM and were operational at the time of the visit. The two (2) fire extinguishers were fully charged and last serviced 05/14/2024. Auditory alarms on exit doors were observed to be functional at this time. BEDROOMS: There are 6 (six) designated resident rooms and 2 (two) staff rooms. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are kept in a hallway closet. LPA discussed with Facility Designee that the current facility sketch includes only 1 (one) staff room and 5 (five) resident bedrooms. Designee stated that all documents were submitted to the Regional Office to request inspection for the additional resident bedroom. LPA will follow up with Facility Designee related this change. BATHROOMS: The resident bathrooms 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 bathrooms initially measured slightly low, however water temperature was adjusted and measured within the required range prior to the end of the visit. KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Continued on LIC 809-C 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 blocked by a tv console and inaccessible. The facility maintained a comfortable temperature throughout the visit. The LPA observed required postings throughout the common space. The laundry area is located in the hallway behind the kitchen. All laundry supplies are locked and inaccessible to residents in care. 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 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. RECORDS: Residents’ records review began at 12:35PM. 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. MEDICATIONS: Medications review began at 01:40PM; medications are centrally stored and locked in a cabinet in the kitchen. Medications are labeled and checked for expiration dates. 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. The facility conducts emergency disaster drills quarterly, with the last drill conducted on 10/16/2024. No citations issued. Exit interview conducted. A copy of the report was provided to Facility Designee.