The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs.

Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Currently there's no resident in the facility. Facility has submitted the mitigation plan and Infection Control Plan.

Operational Requirements: Currently there's no resident in the facility. Therefore the fire clearance requirement is maintained at the present time. The facility has a Dementia Waiver Plan in place. Due to facility has no resident at the present time, the Liability insurance was not in place.

Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility includes kitchen, laundry room, dining area, family room, staff bathroom, three residents' rooms, living room, resident bathroom and an attached garage. All 3 resident bedrooms were toured. Each resident room has two bed, two night stand, dressers, required linen and furniture, sufficient lighting and closet space. Resident's bathroom was toured and it's clean, sanitary and in a good working condition. Bathrooms have the required grabs bars and non-skid mats. The hot water temperature was tested in resident bathroom was 110.8 degrees F which is within the Title 22 Regulation

(See LIC 809C for continuation)

Staffing: The administrator has the updated CPR and First Aid certificate in file. Due to there's no resident reside in the facility now, there's no staff is working at the present time.

Personnel Records/Training: Currently there's no staff is working at the facility, so there's no staff file to be reviewed but the administrator is over 18 years old with the background check cleared and associated with the facility. The administrator certificate is expired on 10/26/23, but the certificate is currently pending in the CCL system since 10/10/23. The administrator also has the updated training hours.

Resident's right-Information: RCFE complaint poster and Personal rights were observed posted

Planned Activity: Sufficient space to accommodate both indoor and outdoor activities was observed.

Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables. The food is also stored properly in the facility.

Incidental Medical and Dental: Due to there's no resident currently reside in the facility, there's no medication to be reviewed at this time. Medical and dental transportation will be provided if needed.

Resident Record and Incident Reports: Due to currently there's no resident reside in the facility, there's no resident file to be reviewed at this time.

Disaster Preparedness: The facility has an updated emergency disaster plan in place. Due to there's no resident in the facility, there's no fire drill or disaster drill were conducted. The facility does have two alternative shelter location.

Residents with Special Health Needs: Due to there's no resident currently reside in the facility, there's no home health resident, no hospice or bedridden resident or restricted health condition resident in the facility.

During the inspection, no deficiencies were observed.

Exit Interview conducted and a copy of the report was provided.

(Due to there's no resident reside in the facility, LPA was not able to interview any resident)