The facility was last visited on 04/21/2022 for an annual visit. It is a single story building with five (05) bedrooms, four (04) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be nonambulatory and one (01) bedridden. The facility serves residents with dementia. Approved hospice waivers for six (06).

At the main entrance, LPA observed postings for the facility’s visitation policy, emergency disaster plan, facility sketch and license, and recent licensing report. Additional postings were observed inside for confidential complaint contacts, emergency contacts, and ombudsman contacts.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 9:15 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. At approximately 9:25 a.m., smoke and carbon monoxide detectors were tested and operational. At approximately 9:35 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 05/03/24. Five (05) out of six (06) residents were observed watching television in the living room together. The living room also contained a piano and exercise equipment. Closets had board games, puzzles, and art supplies. Night lights were hung throughout the hallways.

The facility has five (05) bedrooms. The bedroom nearest the main entrance is designated as a staff room. The staff room was locked and free of hazards. Of the four (04) resident bedrooms, two (02) are shared and two (02) are private. Bedroom #2 had a bedridden resident with an unlocked, immediate exit with a clear pathway to exit. Bedroom #2 and Bedroom #4 had appropriate signs stating “No smoking – Oxygen in use”. Bedroom #3 and Bedroom #4 had private bathrooms. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.

LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Appliances were in good condition, but a panel needed to be replaced above the microwave. This is addressed on an attached note of Technical Violation. Staff were observed preparing food and medication. Cleaning solutions were locked below the sink and in a separate cabinet near the staff room. Medications and sharps were locked above the counter and in a cabinet near the refrigerator.

A washing machine and dryer were located outside of the kitchen. Both were in working order. Detergents were locked in a storage container. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. A ramp with sturdy hand rails and free from tripping hazards led out from the living room and to the back yard. There was a locked storage shed with gardening supplies. The pool was fenced, locked, and inaccessible. All emergency exit paths were free from obstructions. The exit gate was unlocked with a self-closing, inward facing latch. Evacuation routes were posted. Auditory alarms were turned on and functioning. The house phone was called at 10:00 a.m. and deemed operational.

At 10:15 a.m. LPA reviewed resident and personnel files. At 11:30 a.m. LPA conducted staff and resident interviews.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed.

Exit interview conducted. Copy of report provided.