Beginning at 01:37PM, the LPA, along with Licensees, 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:

Hardwired combination smoke and carbon monoxide detectors were tested at 02:44PM and were functional at the time of the visit. Fire extinguisher was observed to be fully charged but purchased on 07/21/2023. During today's visit, Licensee ordered a new fire extinguisher. Auditory alarms on exit doors were observed to be functional during the visit.

KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer on the right-hand side of the kitchen stove. The supply of perishable and nonperishable food is adequate. Appliances in the kitchen appeared clean and functional.

GARAGE/LAUNDRY: The garage was observed adjacent to the facility kitchen. Laundry area is located in the locked attached garage. Laundry detergent and chemicals are stored inaccessible in the locked garage. There is an adequate supply of emergency food and water stored in the garage.

BEDROOMS: There are 5 (five) bedrooms in the facility; 2 (two) private bedrooms for resident use, 2 (two) shared bedrooms for resident use and one (1) staff room. The staff room is kept locked. Resident rooms contained adequate lighting and were furnished appropriately.

Continued on LIC 809-C

COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. There is a television and activities available in the living room area for resident use. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted along the entrance wall. Other required postings were observed along the entrance wall.

EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with tables and chairs for resident use. There are no bodies of water noted on the premises.

FILES: Beginning at 09:50AM, the LPA reviewed 4 (four) staff files for but not limited to: health screening, TB test, training documents, and fingerprint clearance. All staff records were in order. LPA reviewed 3 (three) resident files for but not limited to: pre-admission appraisal, physician's report, personal rights, and outside agency care plans. All resident records were observed to be complete.

MEDICATIONS: Medications are stored in a locked cabinet in the kitchen. The first aid supplies were complete. Medications were reviewed for 2 (two) residents. All medications reviewed were stored and documented in accordance with regulation.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, the LPA reviewed both the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facility conducts emergency disaster drills quarterly with the last documented drill conducted on 09/19/2024.

INTERVIEWS: During the visit, LPA interviewed a random sample of staff and residents. No concerns were noted.

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