Beginning at 09:50 AM, the LPA, along with the 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:

BEDROOMS: There are three (3) bedrooms in the facility; all are designated as dual occupancy rooms and all are designated for resident use. LPA and the 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 contained a direct exit to the outdoors of the facility and is the bedridden approved room. Auditory alarms were observed on facility exits and were functional at the time of the inspection.

BATHROOMS: There are two (2) bathrooms at the facility. One (1) is designated as a resident bathroom and one (1) is designated as a staff bathroom. Both bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in the resident shower and near the resident toilet. All grab bars were properly secured. The water temperature was measured to be between 108.5 and 115.5 degrees Fahrenheit, which is in compliance with regulation.

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.

GARAGE: The garage is located adjacent to the kitchen and was observed to be locked and inaccessible to clients in care. The garage was observed to contain the facility’s washer and dryer, cabinets containing extra care supplies, and a locked chemical storage closet that contained cleaning and laundry chemicals.

COMMON AREAS: This includes the living room, hallway, dining area, Administrator’s office, and sunroom. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room was observed to contain a television and activities for resident use. Additionally, the living room contained a fireplace that was properly screened and contained no tools. The hallway was observed to be clean and free from any obstructions. The hallway was observed to contain two (2) closets that contained extra linens. The dining area was observed to be clean and contained adequate seating for residents’ use. The Administrator’s office was observed to be locked and inaccessible to clients in care. The Administrator’s office contained locked storage for resident medications and facility files. The sunroom was observed to contain adequate shaded seating for resident use. All furniture in the facility was observed to be clean and in good repair. Smoke detectors and carbon monoxide detectors, along with the facility’s fire door, were tested at 10:19 AM and were functional at the time of the visit.

OUTDOOR SPACE: The facility has one (1) emergency exit gate located on the side of the facility. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating for resident use. Cameras were observed on the outdoors of the facility.

RECORD REVIEW: Record review began at 10:31 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. Three (3) staff files were reviewed. All staff files reviewed contained the required documentation and trainings. Four (4) resident files were reviewed. All resident files reviewed contained all required documentation and signatures.

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. The facility’s emergency disaster plan is up to date and adequate. The last emergency disaster drill was conducted on 08/02/2025. 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 staff treat them well and are attentive to their needs. The staff member interview was conducted with the assistance of the Administrator as a translator. The staff member interviewed was knowledgeable on their role and responsibilities, the resident’s rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse.

During today’s visit LPA obtained a copy of the facility’s updated LIC500, resident roster, and liability insurance.

No deficiencies were cited at the time of the visit. Exit interview conducted. And a copy of the report was provided.