The facility was last inspected on 03/26/2021 for a Prelicensing inspection. The facility is a single-story building with 4 bedrooms, 2 bathrooms, living room, dining area, kitchen, covered patio, garage, front yard, and back yard. It has an approved fire clearance for 6 non-ambulatory residents, of which 1 may be bedridden in Bedroom #2. The facility has hospice waivers for 3 residents. The facility has surveillance cameras at the front yard, back yard, and inside the facility. The facility serves residents with Dementia.

Entry: At the main entrance, LPA observed a shaded bench, hand sanitizer, the visitation policy, COVID-related signs, the latest Provider Information Notice (PIN), and a “No Smoking – Oxygen in use” sign. LPA had temperature taken by staff. Staff recorded LPA's arrival on the visitor log. At the entrance hallway, LPA observed a confidential complaint poster, Ombudsman contact, COVID precautions, emergency evacuation plan, and personal rights poster.

Bedrooms: The facility has 4 bedrooms. All bedrooms contained a chair, nightstand, dresser or storage, lamp, bed with adequate bedding, and emergency flashlights. All bedrooms were clean with furniture in good repair.

Bedroom #1 and Bedroom #2 are shared bedrooms. Bedroom #3 and Bedroom #4 are private bedrooms. At approximately 11:25 a.m. LPA observed the sliding doors in Bedroom #2 and Bedroom #3 were locked. Staff confirmed the facility occasionally locks those doors. Administrator confirmed the main entrance is never locked, but the side doors are occasionally locked.

Bathrooms: The facility has 2 bathrooms. The bathroom by Bedroom #1 is designated for staff. That bathroom contained liquid soap, paper towels, a trash can with a tight-fitting lid, and a handwashing instruction sign.

Common Areas: Walls, floors, ceilings, and windows were clean and in good repair. LPA observed the internal temperature at 73 degrees Fahrenheit. One resident was sitting in the living room watching television. The facility maintains confidential files in a cabinet in the living room. 3 residents were sitting at the dining room table. LPA observed a resident schedule hung on the wall. The covered patio contained extra supplies and furniture.

Storage: Between Bedroom #3 and Bedroom #4, staff opened locked storage cabinet with cleaning solutions and hygiene supplies. Another storage cabinet contained adequate fresh linens and towels,

Kitchen: Sharp objects and cleaning solutions were locked under the sink. LPA observed an adequate supply of perishable and non-perishable food. Appliances were functional. At approximately 11:44 a.m. the refrigerator and freezer temperatures were measured at 33 and 0 degrees Fahrenheit, respectively.

Laundry: A functional washer and dryer were observed near the kitchen. Detergents were locked above the machines.

Outdoor areas: LPA observed a ramp outside of Bedroom #3 and Bedroom #2. The handrail was not secure in two places. LPA also observed a 6 inch by 2 inch hole in a screen door by the covered patio. LPA also observed 2 bicycles, a gas grill, and an unlocked shed with no hazards inside.

Safety: The facility has 2 fire doors at both sides of the living room. LPA observed a fire alarm at the front entrance. A fire extinguisher was observed in the kitchen. It was fully charged and last serviced on 08/27/21. At approximately 11:30 a.m. LPA tested smoke and carbon monoxide detector in Bedroom #3. 4 out of 4 smoke detectors were hard-wired and operational. 4 out of 4 auditory devices were on and heard during the inspection. All emergency exit paths were clear and free from debris.

During today's visit, the facility is not in compliance with Title 22 regulations. Observed deficiencies are marked on the LIC 809-D page.

Exit interview conducted. Copy of report, appeal rights, and citation(s) issued.