During today’s inspection, 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 approximately 11:05 a.m. Knives and sharps were observed in a locked box inaccessible at the time of the visit. 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. At 11:10 a.m., the hot water temperature was measured at 109.0 degrees Fahrenheit.

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 several fire extinguishers throughout the facility to be fully charged with a date of 03/13/2025. Required postings were observed throughout the common space.

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.

Restroom: There is one (1) restroom for resident use. The bathroom is located by the main hallway. Bathroom was clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathroom were sufficiently stocked with supplies and paper towels. Starting at 10:55 a.m., the hot water temperature was measured in the bathroom, and it measured within the required range of 105 – 120 degrees Fahrenheit. Personal hygiene items were observed locked and inaccessible to residents in care at the time of the visit.

Bedrooms: There are three (3) bedrooms for resident use. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA observed a staff bedroom on premises.

Laundry: The washer and dryer are located by the main hallway. Staff maintain door locked when not in use. Cleaning supplies were observed locked and inaccessible to residents in care at the time of the visit.

Outdoors: The backyard has a covered patio area with patio furniture for resident use. The LPA observed a shed used for storage purposes locked at the time of the visit. All passageways were observed to be clear of any obstructions. There is (1) side gate with latching mechanisms. No bodies of water noted at the time of the visit.

Report Continued on LIC 809C...

Two (2) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. All files were in order.

Three (3) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All files were complete.

The Administrator’s Certificate is current and valid until 01/18/2027.

The LPA conducted an interview with two staff and one resident during today's inspection. No concerns were noted.

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 they pertain to infection control are adequate. The 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 was conducted on 07/20/2025. The facility is scheduled to have fire drill training before the end of the month.

Medications: Medications review began at approximately 12:25 p.m. Medications are centrally stored and kept in a locked cabinet by the main hallway. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appear to be administered as prescribed at the time of the visit.

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