Starting at 10:25am, the LPA along with the Administrator 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. The following was observed:

KITCHEN: The LPA inspected the kitchen/food service area at 10:43am. Knives and sharps were observed locked under the kitchen sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates.

COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be fully charged with a date of 07/17/2024. Required postings were observed throughout the common space. The LPA observed a fireplace adequately covered at the time of the visit. Activities were observed in the living room. There is a working telephone on premises.

Report 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 LPA observed the garage locked and inaccessible at the time of the visit. Washer and dryer were observed inside the garage. Laundry detergents and cleaning supplies were observed locked and inaccessible at the time of the visit. Personal hygiene items were also observed locked and inaccessible to residents in care. The LPA observed an adequate supply of emergency food and water.

RESTROOMS: There are two (2) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. Hand washing signs were observed posted at the time of the visit. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 10:32am, the hot water temperature was measured in bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit at the time of the inspection.

BEDROOMS: There are four (4) bedrooms for resident use. Two (2) bedrooms are designated for double occupancy and two (2) bedrooms are designated for private / single occupancy. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA observed a staff bedroom on premises which was inaccessible to residents in care at the time of the inspection.

BACKYARD: The backyard has a covered patio area with patio furniture for resident use. There is one (1) side gate that self-latches. All passageways were observed to be clear of any obstructions. No bodies of water noted at the time of the visit.

Report Continued on LIC 809C...

Five (5) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All files were in order.

Four (4) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All records were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; the last one being a fire drill which was conducted on 05/15/2025.

MEDICATIONS: Medications review began at approximately 12:50pm. Medications are centrally stored in a locked cabinet adjacent to the kitchen. PRN Authorization letters on file for all residents. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. No errors observed. Medications appeared to be given as prescribed at the time of the visit.

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