Beginning at 01:08PM, the LPA conducted a tour of the physical plant with Administrator to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted:

The LPA observed fire extinguishers throughout the facility, which were fully charged and last serviced 06/27/2024. Hardwired combination smoke alarms and carbon monoxide detectors were tested at 02:25PM and functioned properly.

Bedrooms: The facility contains 6 (six) resident rooms and 3 (three) staff rooms. Staff rooms are kept locked. The resident bedrooms were observed to be properly furnished and had sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets.

Bathrooms: The facility contains 5 (five) bathrooms; 2 (two) are shared resident restrooms, 1 (one) is a private resident restroom, and 2 (two) are designated for staff and visitors. LPA observed resident bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. The hot water was measured in the common hallway restroom and measured at 108.3 degrees Fahrenheit, which is within the required range.

Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. The facility maintained a comfortable temperature. The living room has a fireplace, which was observed to be screened and inaccessible to residents in care. The LPA observed all required postings in the hallway near the entrance

Report continued on LIC809-C

Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There were no large bodies of water on the premises. Exit gates were observed to be self-closing and latching.

Kitchen/Laundry Room: The kitchen appeared clean and the appliances and fixtures functional. The LPA observed a sufficient amount of perishable and non-perishable food at the facility. Sharp objects are stored in a locked drawer. Adjacent to the kitchen is a laundry room with a locked cabinet containing cleaning supplies.

Garage: LPA observed the locked facility garage, which has been converted to a living unit for staff. The garage contains 2 (two) staff rooms, a staff restroom, staff kitchen area, as well as storage for incontinence are items and emergency food and water supply.

Record Review: The LPA reviewed 5 (five) resident files for documents including, but not limited to Admission Agreement, Physician's Report, current Needs & Service Plans, and Personal Rights. All 5 (five) resident files observed were complete and contained all documents. The LPA reviewed 3 (three) staff files for documents including but not limited to: staff training records, background clearance, and health screenings. All staff files appeared complete and current.

Infection Control/Emergency Disaster Plan: During today's visit, LPA reviewed the facility's Infection Control Plan and Emergency Disaster Plan, which were both complete and updated annually as required. Disaster drills are conducted quarterly, with the last documented drill on 09/05/2024.

Medications: At 02:00PM, a medication review was initiated. Medications are centrally stored and locked in a cabinet in the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medication and destruction record. No errors observed during the medication review. First aid kit was observed to be complete.

Interviews: Throughout the visit, LPA interviewed 2 (two) staff and 1 (one) resident. No concerns were voiced during the visit.

No citations issued. Exit interview conducted. A copy of today's report was provided.