The facility was last visited on 04/02/25 for an annual inspection. It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 nonambulatory residents, of which 1 may be bedridden in Bedroom #2. The facility serves residents with dementia. Approved hospice waivers for three (03).

At 12:40 p.m. LPA reviewed resident and personnel files. All files were complete and available for audit.

LPA observed a maintained front yard with a fruit-bearing tree and an unlocked front gate. At the main entrance, LPA observed postings for emergency contacts, confidential complaint contacts, Ombudsman contacts, personal rights, theft and loss policy, administrator certificate, facility sketch with evacuation routes, visitation policy, activity schedule, and COVID postings. LPA observed a screening station with digital thermometer, visitor log, sanitizer, masks, and additional PPE.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 1:50 p.m. LPA measured the room temperature to be 74 degrees Fahrenheit. Four (04) residents were observed watching television in the living room together. One (01) resident was observed outside feeding the birds. Reading materials, activity books, humidifier, and games were available near the dining room table. A closet with a sufficient supply of fresh linens and incontinence supplies was located in the hallway.

The facility has four (04) bedrooms. Bedroom #1 serves as a staff room. It was unlocked and free of hazards. Resident bedrooms were all shared bedrooms. All bedrooms contained a chair, lamp, nightstand, storage, emergency lights, and a bed with adequate bedding. All furnishings were clean and in good condition. All hospital-style beds had wheels in the locked position.

• 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.

LPAs observed an adequate supply of perishable and non-perishable supplies of food in the kitchen. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter. Cleaning solutions were locked below the sink. Medications were locked in a cabinet by the refrigerator. At approximately 2:25 p.m. LPA conducted a medication review for one (01) resident. All medications were stored in proper quantities. At 2:40 p.m. LPA observed two (02) fully charged fire extinguishers in the kitchen.

The garage was locked with an electronic number pad and contained cleaning solutions, extra supplies, an extra refrigerator, and a laundry area. A washing machine and dryer were observed inside. Both were in working order. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. Ramps leading out from Bedrooms #2 and #3 were stable with secure handrails. Fruit bearing trees were present in the back yard. The emergency exit path was free from obstructions. The exit gate was unlocked. Five (05) out of five (05) auditory alarms were turned on and functioning. At approximately 3:00 p.m. smoke and carbon monoxide detectors were tested and operational. At 3:05 p.m. the house telephone was called and deemed operational.

No immediate health and safety risks were observed during today’s visit.

Exit interview conducted. Copy of report provided.