The facility was last visited on 10/06/2021 for an annual visit. It is a single story building with 7 bedrooms, 3 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 nonambulatory residents, of which 1 may be bedridden. The facility serves residents with dementia. Approved hospice waivers for 5. LPA observed a maintained front yard. Signs were posted on the front door for the facility’s masking, handwashing, and visitation policies, along with a “No Smoking- Oxygen in use” sign. LPA was screened for infectious disease upon entry. The screening station contained a standing digital thermometer, hand sanitizer, surgical masks, KN95 masks, and 2 visitor logs for family and essential workers. Visitor logs tracked temperatures. Administrator confirmed that visitors are screened for symptoms and must show proof of vaccination. Resident vital signs are checked twice daily. Postings at the front included ombudsman contacts, confidential complaint contacts, emergency contacts, COVID precautions, facility sketch, Emergency Disaster Plan, administrator certificates, non-discrimination policy, personal rights, rights of resident councils, and house rules.

A resident was observed eating a meal in the dining room. Reading material, activities, and socially distanced furniture were located in the living room. Music was played in a resident bedroom and in the kitchen. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. Surveillance cameras are used in common areas. The facility had 7 bedrooms. All bedrooms were private. One bedroom was designated for staff. The staff room was locked and free of hazards. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. LPA observed family visiting with one resident. Other residents were watching television in their rooms. Emergency exits were unlocked and unobstructed. 8 out of 8 auditory alarms were on and functioning.

The back yard was maintained and free of hazards. A covered patio area contained furniture in good condition. Exit gates were unlocked with inward facing latches. Emergency exit paths were free from obstructions. At 2:50 p.m. LPA tested the dual-function smoke and carbon monoxide detector to be operational. When tested, detectors functioned simultaneously and were hardwired.

LPA observed an adequate supply of perishable and non-perishable food in the kitchen and pantry area. At approximately 2:55 p.m. LPA measured the refrigerator and freezer temperatures to be within regulations. A temperature log and facility menu were posted in the kitchen. Appliances and surfaces were sanitary. Sharps were locked below the counter top. Cleaning solutions were locked near the laundry area by the kitchen. The laundry area contained an operable washer and dryer in good condition. At 2:58 p.m. LPA measured the room temperature to be 81.4 degrees Fahrenheit. At 3:08 p.m. LPA observed 2 fully charged fire extinguishers, last inspected on 07/28/2022. At 3:15 p.m. staff tested the call system to be on and functional.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report provided.