KITCHEN: The LPA inspected the kitchen/food service area at 9:54 p.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and 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 are stored in a cabinet next to the stove inaccessible to residents in care. At 10:04 a.m., the water temperature was tested in the kitchen faucet, and it measured 122.9 degrees Fahrenheit.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector are hard-wired and were tested and operational at the time of the visit. The fire extinguisher was observed to be purchased on 09/21/2023.

(Report Continued on LIC 809C...)

GARAGE/BACKYARD: The garage is kept locked at all times. The facility has an adequate supply of emergency food and water which was observed to be in good condition. The washer and dryer were observed inside the garage inaccessible to residents in care. Detergents and cleaning solutions were observed locked an inaccessible. The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There is one (1) gate with self-latching mechanisms observed. Auditory alarms were observed functioning at the time of the visit. No bodies of water were noted at the time of the visit.

BEDROOMS: There are five (5) resident bedrooms. Four (4) bedrooms are single occupancy, and one (1) bedroom is double occupancy. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There is a staff room on premises.

RESTROOMS: There are two (2) resident restrooms. The first restroom is located in the hallway and the second restroom is located in bedroom #6. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The LPA observed a cabinet in bathroom #1 with extra towels and linens. The hot water temperature was measured in both bathrooms; the first bathroom measured 123.6 degrees Fahrenheit at 9:49 a.m.; and the second bathroom measured 116.7 degrees Fahrenheit at 9:52 a.m. The staff adjusted the water temperature at the time of the visit.

(Report Continued on LIC 809C...)

Four (4) 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 personnel files were in order. The last emergency disaster drill took place on 11/02/2023.

At the time of the visit, the LPA obtained the following documents: LIC 500 Personnel Report, LIC9020 Client Roster, and a copy of the liability insurance.

The LPA conducted interviews with two (2) staff member between 12:00 p.m. and 12:20 p.m.

MEDICATIONS: Medications review began at approximately 12:25 p.m.; medications are centrally stored and locked in a closet by the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

Exit interview conducted. No deficiencies issued. The report was reviewed and a copy was provided.