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25 | Licensing Program Analyst (LPA) Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met Linda Renard (Administrator) and explained the reason for the visit. The facility is licensed to serve six non-ambulatory residents ages 60 and over and may retain up to three hospice residents. The facility is not operating within the scope of its license. There is a 7th resident sharing a bedroom with another resident. This resident will be referred as Resident 7 (R7). Interviews with administrator and staff revealed that R7 is non-ambulatory (uses a walker), has medication locked and is assisted with administering medication, is unable to leave the facility unassisted, has possible dementia, and goes on outings with the rest of the residents and facility staff. R7 is the mother of the administrator’s best friend and administrator considers her a family member and not a resident.
The facility is located in a residential area. A tour of the single-story facility included: 4 resident bedrooms, 2 resident bathrooms, living room, kitchen, dining area, front yard, backyard, and attached garage. LPA and Linda toured the facility and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in the residents’ bathrooms and measured at 119.7 and 115.5 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. The shower has non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in one of the resident’s bathroom cabinet. Smoke detectors combined with carbon monoxide were observed in each room and throughout the facility and are properly operating. A fire extinguisher was observed in the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Knives are kept locked in a kitchen cabinet. Cleaning chemicals are kept locked in the garage.
(CONTINUED TO LIC 809C) |