Beginning at 10:33AM, the LPA, along with staff and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN/LAUNDRY/GARAGE: LPA inspected the kitchen at 10:33AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility had a sufficient supply of perishable and non-perishable food. At 10:40AM, LPA observed three (3) cans of jelled cranberry sauce expired on 04/03/2025 and three (3) dented cans of evaporated milk. Staff discarded the cans immediately. Cleaning supplies are located in a locked under-sink cabinet. Knives are in a locked kitchen cabinet. Laundry room contains locked storage for cleaning chemicals. The LPA observed the garage to be locked and contained an office area, extra food, emergency water supply, and additional storage.

BEDROOMS: There are eight (8) total bedrooms in the facility; two (2) are designated as staff rooms; both staff rooms were observed to be locked. There are six (6) private resident bedrooms, all with private bathrooms and exits to the exterior. Auditory exit alarms were tested and functioned properly. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

Report Continued on LIC 809-C

• 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.

COMMON AREAS: This includes the living room and dining room areas. LPA observed common areas to be clean and properly furnished. Exit doors contain alarms and were functional at the time of the visit. LPA observed required postings in the entrance hallway. Fire extinguishers were fully charged and last serviced on 04/03/2025. Hardwired combination smoke and carbon monoxide detectors were tested at 11:08AM and all were functional at the time of the visit. No fire clearance concerns observed.

OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear and free of obstruction. There were no bodies of water on the premises.

MEDICATION REVIEW: Beginning at 11:10AM, LPA reviewed medications for two (2) of six (6) residents. Medications were centrally stored and locked inaccessible in a hallway closet. All medications reviewed were properly documented and no deficiencies were observed during medication review.

RECORD REVIEW: Beginning at 11:45AM, LPA reviewed six (6) out of six (6) resident files and three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training, first aid certification, and fingerprint clearance. All resident and personnel files were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 05/20/2025. All documents reviewed were updated and in compliance.

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