Beginning at 09:40 a.m., 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 09:40 a.m. Knives and sharps were observed in a kitchen drawer locked and inaccessible. Cleaning supplies were observed in a locked cabinet and under the kitchen sink 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.

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 a fire extinguisher to be fully charged with a date of 04/02/2025. Required postings were observed throughout the common space. There is a working telephone on premises. Cameras observed in the common areas. Nightlights were observed throughout the hallways and inside the bathrooms.

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.

Restrooms: There are two (2) restrooms for residents’ use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 10:05 a.m., the hot water temperature was measured in bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit. Personal hygiene items were observed locked and inaccessible to residents at the time of the visit.

Bedrooms: There are five (5) bedrooms for resident use. Four (4) bedrooms are designated as private / single bedrooms, and one (1) bedroom is designated as a shared / double occupancy. Bedrooms were observed to be furnished appropriately with appropriate furnishings, and sufficient lighting. Additional clean linens and towels were observed in a closet by the main hallway. There is no staff room on premises

Garage / Outdoors: The garage was inaccessible to residents in care at the time of the visit. There is a second refrigerator with additional food for residents. The LPA observed an adequate amount of emergency food and water. A sufficient supply of Personal Protection Equipment (PPE) was observed. Additional cleaning supplies and detergents are kept in the garage locked and inaccessible to residents in care. Washer and dryer were observed inside the garage. There is a working generator for emergency purposes. The backyard has a covered patio area with patio furniture for residents’ use. The LPA observed a locked shed used for storage purposes. All passageways were observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms. No bodies of water noted at the time of the visit.

Report Continued on LIC 809C...

Six (6) 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.

Six (6) 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 personnel files were complete. The Administrator’s Certificate is valid until 07/05/2026.

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; last fire drill conducted on 10/09/2025.

Medications: Medications review began at approximately 12:30 p.m. Medications are centrally stored and kept in a locked cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications are properly documented on the centrally stored medication and destruction record. Medications appear to be administered as prescribed at the time of the visit.

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