Beginning at 08:45 a.m., LPA and 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.

There are five (5) bedrooms in the facility for resident use; four (4) bedrooms are designated as private, single occupancy rooms, and (1) bedroom is designated as a double, shared occupancy room. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. There is a closet with additional clean linens and towels for resident use. There are three (3) restrooms in the facility for resident use. Restrooms were observed to be clean and in sanitary condition. Grab bars and slip resistant floor were observed. Restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured starting at 08:58 a.m., and they measured within the required range of 105 – 120 degrees Fahrenheit during the inspection.

The LPA observed the garage which was inaccessible to residents at the time of the visit. There is a washer and dryer inside the garage. Toxins and detergents were observed locked and inaccessible during the inspection. A sufficient supply of emergency food and water was observed.

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.

The LPA observed the common areas. This includes the living room and a dining room. 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 fire extinguisher was observed to be fully charged with a charge date of 05/14/2025. LPA observed required postings throughout the common space. Activities were observed in the common areas. There is a functioning telephone on the premises.

The kitchen/food service area was observed at approx. 09:05 a.m. Knives and sharps were observed in a cabinet. Cleaning supplies and other chemicals are kept locked under the sink area. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. At 09:08 a.m., the hot water temperature was measured in the kitchen sink, and it measured 120 degrees Fahrenheit.

Record review began at approx. 09:40 a.m. Four (4) 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, PRN authorization letters, and current needs and services plan. Files were complete. Three (3) personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.

During today’s visit, LPA reviewed the facility’s emergency disaster plan. Emergency disaster drill are being conducted quarterly as per regulation; last one conducted on 12/01/2025.

LPA conducted a medications review. Medications are centrally stored in a cabinet by the kitchen. Medications are properly documented on the centrally stored medications and destruction records. Medications appear to be administered as prescribed at the time of the visit.

Exit interview conducted. A copy of report was provided.