Routine inspection·July 25, 2024

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 02:28PM. LPA initially met with facility staff. Administrator arrived shortly after LPA's arrival. Entrance interview conducted. Beginning at 02:42PM, the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and recently serviced on 03/19/2024. Hardwired combination smoke and carbon monoxide detectors were tested at 05:20PM and all were functional at the time of the visit. No fire clearance concerns were observed. BEDROOMS : There are 8 (eight) total bedrooms in the facility; 2 (two) are designated as staff rooms; both staff rooms were observed to be locked. There are 6 (six) private resident bedrooms, all with private bathrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. BATHROOMS : There are 6 (six) private resident bathrooms and 1 (one) guest/staff bathroom. Restrooms were observed to be equipped with nonskid surfaces. Grab bars were observed in the bathrooms. The water temperature was measured in various resident bathrooms and measured within the required range. COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. Exit doors contain alarms and were functional at the time of the visit. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs Report Continued on LIC 809-C for resident use. All passageways were observed to be clear. There were no bodies of water on the premises. . KITCHEN/LAUNDRY ROOM/GARAGE : Kitchen was observed to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Cleaning supplies are located in a locked under-sink cabinet. Knives are in a locked kitchen cabinet. Laundry room contains locked storage for cleaning chemicals. The LPA observed the garage to be locked and contain an office area, extra food, emergency water supply, and additional storage. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill conducted on 06/05/2024. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All 5 (five) resident files and all 5 (five) staff files observed contained all required documents. MEDICATION REVIEW: Medications were observed to be in a locked hallway closet. Medications for 2 (two) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. INTERVIEWS: During today's visit, LPA interviewed 2 (two) staff and 6 (six) residents. No concerns were identified. During today's visit, LPA requested a copy of the facility's liability insurance and a copy of the annual sprinkler inspection be emailed to the LPA. No citations issued. Exit interview conducted. A copy of today's report was provided.