Beginning at 12:11PM, the LPA, along with facility management 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:

Fire extinguishers were observed to be fully charged and recently serviced 10/04/2024. Hardwired combination smoke and carbon monoxide detectors were tested at 02:10PM. All were functional at the time of the visit.

BEDROOMS: There are (8) eight bedrooms in the facility; the facility has (6) six private bedrooms for resident use, and (2) two staff rooms. Both staff rooms are kept locked. Lighting in the resident rooms appeared adequate. All resident rooms were observed and were furnished appropriately at the time of the visit.

BATHROOMS: There is (1) half bath and (1) full bathroom in the hallway. There is (1) one additional private bathroom for resident use; the half bathroom in the hallway is designated for staff and guests, the full bathroom in the hallway is designated for resident use. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature in shared resident bathroom measured at 115.1 degrees Fahrenheit, which is within the required range.

COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. All furnishings were observed in good condition. All required postings were observed in common areas.

Report Continued on LIC 809-C

KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer next to the sink. Cleaning supplies are locked in an under-sink cabinet. The supply of perishable and nonperishable food is adequate. Appliances in the kitchen were clean and appeared functional. There is an adequate supply of emergency food and water.

GARAGE: The garage was observed locked and inaccessible to residents in care. The garage contained storage, a refrigerator/freezer containing extra food, as well as the facility's laundry area.

FILES: Beginning at 12:33PM, LPA observed 5 (five) resident files for items including but not limited to physician's report, physician's orders, needs and service appraisals, and personal rights. All resident files were in order. LPA observed 2 (two) staff files for items including but not limited to health screening, TB test, criminal record clearance, and training records. All staff records were observed to be complete.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: The facility has an infection control plan and emergency disaster plan; both of which were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill documented on 11/03/2024.

MEDICATIONS: Medications are stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a first aid manual. At 01:45PM, medications for 2 (two) residents were observed. Medications for both residents were observed to be properly stored and documented per regulation.

INTERVIEWS: During today's visit, LPA conducted interviews with both staff and residents. No concerns were noted during interviews.

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