A file review was conducted prior to the visit. The facility was last visited on 01/19/23 for a prelicensing visit. It is a single story building with five (05) bedrooms, three (03) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for five (05) nonambulatory residents and one (01) bedridden resident in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for two (02).

A facility tour with the administrator was conducted at 10:15 a.m. At the main entrance, LPA observed postings for the facility license, facility sketch, administrator certificates, COVID precautions, emergency disaster plan, visitation policy, a blank copy of an admission agreement, nondiscrimination notice, rights of resident councils, personal rights, ombudsman contacts, confidential complaint contacts, and the theft and loss policy. A sign hung on the main entrance to indicate “No Smoking – Oxygen in use”.

A screening station at the front contained a mounted digital thermometer, masks, hand sanitizer mounted on the wall, and a visitor’s log.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 10:20 a.m. LPA measured the room temperature to be 73.0 degrees Fahrenheit. Two linen closets in the hallway contained adequate supplies of fresh linens. A cupboard contained a complete first aid kit. At 10:25 a.m. staff were observed engaging residents in physical exercises in the living room. Two (02) living rooms contained reading materials, board games, and a grand piano. A fireplace was appropriately covered.

The facility has five (05) bedrooms. Bedroom #1 - #4 serve nonambulatory residents. Bedroom #5 is a shared room for a bedridden resident and a nonambulatory resident. Bedroom #1 and Bedroom #2 are currently unoccupied.

The facility has three (03) bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. One shared bathroom near Bedroom #5 contained a shower chair and a commode. At approximately 10:30 a.m. LPA measured the water temperature to be 110.5 degrees Fahrenheit.

LPA observed an adequate supply of perishable and non-perishable foods in the refrigerator, freezer, and pantry. The pantry also contained supplies of emergency food and water. The stove hood was clean. Appliances were in good condition. Allergen information and emergency contacts were posted on the fridge. An activity calendar hung in the dining room. Sharps were locked below the counter. Cleaning solutions were locked below the sink. Medications were locked in a file cabinet in the dining area. The call system was routed to the kitchen where staff observed any requests for care. A washing machine and dryer were located in the laundry room near Bedroom #5. Both were in working order. Detergents were locked near the appliances.

LPA observed an enclosed patio area in the rear of the facility. The patio contained furniture in good condition along with board games and reading material. The ramp leading from the living room to the patio was secure. The back yard was maintained with additional furniture and tree canopies. The garage was locked and contained extra hygiene supplies, assistive devices, and emergency supplies.

All emergency exit paths were free from obstructions. The exit gate was unlocked. Four (04) out of four (04) auditory alarms were turned on and functioning. At approximately 10:40 a.m., the smoke and carbon monoxide detectors were tested and operational. The fire door to Bedroom #5 closed when tested. At approximately 10:45 a.m. LPA observed a fully charged fire extinguisher in the dining room. It was last inspected on 11/16/23.

LPA reviewed resident and personnel files at 9:45 a.m., reviewed the Compliance and Regulatory Enforcement (CARE) Tools with the administrator at 11:00 a.m., and interviewed staff and residents at 12:00 p.m. 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.