BEDROOMS: There are six (6) private resident bedrooms. The LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The facility has one common area between bedroom #4 and bedroom #5 that is used as a staff room. All direct exits were clear, and no obstructions were noted.

RESTROOMS: There are four (4) restrooms of which two (2) are designated for resident-use, one (1) is designated for staff-use, and one (1) is designated as a communal restroom by the common area. Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The restrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. Between 12:33PM – 12:37PM, hot water temperature was measured in resident bathrooms and were between 112.7 degrees F – 116.1 degrees F, which is within the required range.

KITCHEN: The LPA inspected the kitchen/food service area at 12:50PM. 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 expiration dates and food labels had expiration date clearly marked. Knives and chemicals were locked inaccessible in the kitchen cabinet. Fire extinguisher was located by the kitchen area and was last purchased on 09/30/2024.

Report Continued on LIC 809-C

OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate which was observed to self-latch. No bodies of water noted. The washer and dryer appeared operational and are located in the garage.

MEDICATION REVIEW: At 12:54PM, LPA reviewed medications for three (3) residents. Medications are centrally stored and locked in the kitchen cabinet. 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.

RECORD REVIEW: Beginning at 01:22PM, LPA reviewed six (6) out of six (6) resident files and four (4) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident and personnel files were in order.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency drills are conducted quarterly as is required, with the last drill conducted on 10/22/2024.