The facility was last visited on 05/18/2022 for an attempted annual visit. It is a single story building with 5 bedrooms, 3 bathrooms, kitchen, garage, office, common areas, and outdoor areas. It has an approved fire clearance for 4 ambulatory clients.

Entry: Upon entry, LPA observed signs hung on the front door for the facility’s masking and visitation policies. A secure handrail was located near the front steps. Screening: LPA was screened for infectious disease upon entry. The screening station contained surgical masks, N95 respirators, hand sanitizer, sanitizing wipes, gloves, a digital thermometer, and a visitor log. Screening procedures were posted at the front entrance. LPA observed a visitor log with contact tracing information, temperatures, a screening questionnaire, and symptom and vaccination checks. LPA also observed documentation of client and staff screenings and a facility cleaning log. LPA observed staff screen clients upon entry.

Bedrooms: The facility has 5 bedrooms. All bedrooms are private, and one bedroom is designated for staff. The staff bedroom was sanitary and free of hazards. A storage closet in the staff bedroom contained emergency supplies, first aid kits, and extra linens. All bedrooms contained a nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. The door in Bedroom #4 which led to the garage was locked.

Bathrooms: The facility has 3 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, and a trash can with a tight fitting lid. LPA observed visual aides, grab bars, and a non-skid mat in the large bathroom. At 2:24 p.m. LPA measured the water temperature in the large bathroom to be 107.7 degrees Fahrenheit.

Laundry: LPA observed a washer and dryer in a room near the kitchen. The appliances were in good condition. Detergents and cleaning supplies were locked above the appliances. An exit door was locked with a simple turn lock.

Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. The living room had television, activities, games, house phone, and physically distanced furniture. LPA observed postings in the dining room for resident rights, Emergency Disaster Plan, grievance procedure, house rules, confidential complaints, weekly menu, activity calendar, facility license, administrator certificate, and COVID policies. At 2:21 p.m. LPA measured the room temperature to be 74 degrees Fahrenheit. The office area contained locked file cabinets with resident records and medications. The fireplace in the living room was turned off. The gas line was capped.

Safety: All emergency exit paths were free from obstructions. The rear exit gate was locked with a padlock. The front exit gate was unlocked. Administrator stated that the gate remains unlocked at night but locked during the evening for safety. LPA advised administrator to apply for a waiver to lock the gate at night. Administrator stated the gate will remain unlocked. At 2:23 p.m. Administrator tested the dual-purpose smoke and carbon monoxide detector to be operational. At 2:25 LPA observed a fully charged fire extinguisher in the kitchen. It was purchased on 08/17/2021 and the receipt was attached.

Outdoor areas: LPA observed a clean outdoor space with furniture in good condition. A gas grill was disconnected. All exit paths were free from obstructions.

Garage: LPA observed PPE, emergency food, hazardous chemicals, and extra supplies in the locked garage.

At approximately 2:50 p.m. LPA and Administrator reviewed the Infection Control Domain of the Compliance and Regulatory Enforcement (CARE) Tools. All staff have been FIT tested and trained on PPE use. All emergency contact information is up to date. The facility has reported positive COVID cases and is able to accommodate COVID positive clients.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report provided.