INTERVIEWS: From 9:37 a.m. - 9:55 a.m. One (1) staff and three (3) resident interviews were conducted during the inspection. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit.

COMMON AREAS: At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 10:10 a.m., smoke detector(s) and carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 09/01/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 03/07/2025 and conducted monthly. Activities were observed in the common areas. Hygiene items were observed locked and inaccessible in a hallway closet. The facility has a working telephone on the premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction.

BEDROOMS: The facility is a single-story residential home with four (4) bedrooms of which three (3) are for resident use and one (1) for staff use. Resident bedrooms are shared, double occupancy bedrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Staff room remains locked at all time.

Report Continued on LIC 809C...

GARAGE: The garage was observed locked and inaccessible to residents at the time of the visit. The washer and dryer were observed inside the garage. Cleaning supplies and detergents were observed locked and inaccessible at the time of the visit. The facility has a sufficient amount of emergency food and water which was observed to be in good condition. The LPA observed a sufficient supply of Personal Protection Equipment (PPE).

KITCHEN: The LPA inspected the kitchen/food service area at 10:02 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Food labels were inspected and checked for dates and expiration. Dates and food labels had expiration date clearly marked. The knives and sharps were observed in a locked cabinet inaccessible.

BACKYARD: The backyard has an area equipped with outdoor furniture including a table and chairs for resident use with a portable outdoor umbrella for shade. Emergency exits and passageways were observed free of obstruction. There was one (1) gate that self-latches. No bodies of water were noted at the time of the visit.

RECORDS: Records review began at 10:10 a.m.; five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All records were in order. Five (5) personnel records 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.

Report Continued on LIC 809C...

MEDICATIONS: Medications review began at approximately 12:15 p.m. Medications are centrally stored and locked in the hallway closet adjacent to the garage entrance; Medications for five (5) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. PRNs have physicians order on file. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed.

Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, and current Liability Insurance.