The LPA 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.

BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) is designated as a staff room. The staff room is kept locked at all times. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

RESTROOMS: There are five (5) restrooms. Three (3) are designated as private resident restrooms and two (2) are designated as shared/ common resident restroom. Resident restrooms were observed to be equipped with a slip resistant surface. Grab bars were observed in the bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured all resident restrooms and ranged between 108.6- 113.9 degrees Fahrenheit, all within the required range.

Report Continued on LIC 809C...

KITCHEN: The LPA inspected the kitchen/food service area at 10:19 a.m. The kitchen faucet was measured for hot water temperature, and it measured 116.1 degrees Fahrenheit at 10:19 a.m. Knives and sharps were observed in a locked box that sits on the counter. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates.

RECORDS: Record review began at approx. 10:30 a.m. Resident Records were reviewed beginning at 10:33 a.m. four (4) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:07 a.m. six (6) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order.

Infection Control / Emergency disaster planning: During today’s visit LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate.

Report Continued on LIC 809C...

MEDICATIONS: Medications review began at approximately 11:46 a.m. The medications are in a locked closet adjacent to the kitchen in the living room area. Medications for four (4) residents were reviewed. Medications reviewed were found to be self administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed.

INTERVIEWS: Two (2) staff and Two (2) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit.

LPA obtained the following documents - Resident roster ; LIC 9020, Staff roster ; LIC 500, and copy of the current Limited Liability insurance.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.