Beginning at 10:27 AM, the LPA, along with facility 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:

KITCHEN: LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed a secured cabinet located under the sink which contained cleaning supplies. LPA observed the kitchen to contain a wall mounted fire extinguisher that was fully charged and was last serviced on 09/09/2024.

OUTDOOR SPACE: The facility has two (2) emergency exit gates located in the front yard of the property; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. The backyard contains one (1) secured shed that was observed to contain cleaning chemicals. LPA observed an appropriately fenced off pool that was locked and inaccessible to residents in care.

Continued on LIC 809C.

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

BEDROOMS: There are three (3) bedrooms in the facility; one (1) is a dual occupancy room and two (2) are single occupancy rooms. All are designated for resident use. LPA and facility Administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #3 is the bedridden approved room and contains a direct exit to the outdoors of the facility. Auditory alarms were observed on facility exits and all were functional at the time of the visit.

BATHROOMS: There are two (2) bathrooms at the facility. One (1) is designated as shared resident bathroom and one (1) is designated as a private resident bathroom. All bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in all bathrooms and all were properly secured. The water temperature was measured between 116.8 and 118.0 degrees Fahrenheit, which is in compliance with regulation.

RECORD REVIEW: Record review began at 11:05 AM. 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, consent forms, and personal rights. Four (4) staff files were reviewed. All staff files contained the required documents and trainings. Three (3) resident files were reviewed. All resident files contained all required documentation. No deficiencies were observed during record review.

Continued on LIC 809C.

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 they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 07/07/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator.

INTERVIEWS: LPA interviewed one (1) staff and one (1) resident. The resident interviewed stated that the staff treat them well and are attentive to their needs. The resident interviewed had no concerns with the facility. The staff member interviewed was knowledgeable on their role and responsibilities, the resident rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse. The staff interview was conducted with the assistance of the Administrator acting as a translator.

During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance.

No deficiencies were observed during today’s inspection. Exit interview conducted and copy of the report was issued.