COMMON SPACES/ BACKYARD/GARAGE: In the common areas, walls and flooring were checked for cleanliness and were in good condition. At the time of the visit, living room and dining room furniture appear to be in good condition. The fire extinguisher appeared to be fully charged and last inspected 10/02/2024. The smoke and carbon monoxide detectors were tested at 12:22 p.m. and functioned properly during the visit. The last emergency disaster drill took place on 12/02/2024 and conducted quarterly. Activities were observed in the common areas. There is a washer and dryer on the premises located in the garage which remains locked at all times. Laundry soap and extra cleaning supplies are stored in the garage locked inaccessible to clients in care. The facility has a sufficient supply of emergency food and water located in the garage. There is a gym area with cardio machines for client use. There is an open office area. Staff files are stored in the garage in a locked filing cabinet. The backyard has a covered patio area with patio furniture including a table and chairs for client use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. Report Continued on LIC 809C...

MEDICATIONS: Medications review began at approximately 12:00 p.m. The medications are locked in a cabinet in the kitchen. Medications for six (6) clients were reviewed. Medications reviewed were found to be self administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed at this time.

RECORDS: PERSONNEL FILES: were reviewed beginning at 10:27 a.m. for six (6) staff including the Administrator and House Manager. Files were reviewed for, but not limited to personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order at the time of the visit. CLIENT RECORDS: were reviewed beginning at 11:07 a.m. for six (6) clients. Files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All files were in order at the time of the visit. The LPA and staff reviewed P&I Money at 11:59 p.m. for all six (6) clients who have their cash resources save guarded by the facility. Cash resources were found to be separate and intact and not commingled with facility funds or petty cash.

INTERVIEWS: From 1:10 p.m. – 1:15 p.m. LPA conducted interviews. Two (2) staff interviews were conducted. Staff interviews revealed that staff are knowledgeable in client right, different forms of abuse and reporting procedures. No concerns noted at the time of the visit. Two (2) client interviews were attempted, one (1) was conducted. No concerns noted at the time of the visit.

During today’s visit, the LPA obtained copies of the following: LIC 500 Personnel Report, LIC 9020 Resident Roster, current liability insurance, and Surety Bond.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.