KITCHEN: The LPA inspected the kitchen/food service area at 10:11AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. The knives and sharps are stored in a cabinet next to the stove inaccessible to residents in care.

BEDROOMS: There are five (5) resident bedrooms. Four (4) bedrooms are single occupancy, and one (1) bedroom is double occupancy. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There is a locked staff room on premises by the garage.

RESTROOMS: There are two (2) resident restrooms. The first restroom is located in the hallway and the second restroom is located in bedroom #1. Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. Between 10:21AM – 10:23AM, hot water temperatures were measured in both bathrooms and were between 117.2 degrees F – 117.7 degrees F, which is within the required range.

(Report Continued on LIC 809C...)

GARAGE/BACKYARD: The garage is kept locked at all times. The facility has an adequate supply of emergency food and water which was observed to be in good condition. The washer and dryer were observed inside the garage inaccessible to residents in care. Detergents and cleaning solutions were observed locked and inaccessible. The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There is one (1) gate with self-latching and self-closing mechanisms observed. Auditory alarms were observed functioning at the time of the visit but were turned off to keep the door open. Administrator stated they will replace the auditory alarms to ones that allow the doors to be left open without the alarms having to be turned off. No bodies of water were noted at the time of the visit.

MEDICATIONS: Medications review began at approximately 10:34AM; medications are centrally stored and locked in a closet by the kitchen. LPA reviewed medications for three (3) residents and observed all medications including PRNs to be labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. 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.

RECORD REVIEW: Beginning at 10:57AM, LPA reviewed six (6) out of six (6) resident and three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident and personnel files were in order.

(Report Continued on LIC 809C...)

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the 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 drills are conducted quarterly as is required, with the last drill conducted on 11/02/2024.

At the time of the visit, the LPA obtained the following documents: LIC 500 Personnel Report, LIC9020 Client Roster, and a copy of the liability insurance.

Exit interview conducted. No deficiencies issued. A copy of the report provided.