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.

Kitchen: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. All food is covered, stored and marked appropriately. Kitchen areas are kept clean and free from litter, insects and pests. Cleaning supplies and disinfectants are stored under the sink and in the garage, inaccessible to clients. Knives are stored in a locked cabinet in the kitchen.

Common areas: Living and dining room furniture were observed to be in good condition. Carbon monoxide and smoke detector were tested and operational at the time of the visit. LPA observed required postings throughout the common space. The backyard had a table and umbrella. No bodies of water noted. The washer and dryer are in a laundry room.

Restrooms: The three (3) restrooms were clean and sanitary and in operating condition with non-skid mats. Secured grab bars were present.

Bedrooms: There are four (4) resident rooms, which were furnished with appropriate furnishings. Linen cabinets were located outside of the rooms, which stocked extra linens and towels.

Continued on 809-C

• 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.

Records: LPA reviewed resident and staff records. Five (5) resident files were reviewed for, but not limited to, the following: signed Admission Agreements, Medical Assessments / LIC 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. The facility does not handle cash resources.

The LPA reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. Administrator Certificate expires on 10/27/25. All files were complete. LPA reviewed five (5) staff training records for Annual Training Requirements of 20 plus hours. Trainer met the requirements to train staff.

Medications: Medications are centrally stored and locked in a cabinet in the kitchen / second living room. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA reviewed a sampling of resident’s medications, no medications labels were altered, no expired medications, and medications were stored in original containers.

Disaster Preparedness: The current emergency disaster forms are accessible to staff and emergency phone contacts are posted. The facility conducts quarterly disaster drills. The fire extinguisher were charged and inspected in February of 2025. A set of keys is available for staff on all shifts to access full facility in an emergency.

Exit interview conducted. A copy of the report was printed.