Facility is licensed to serve six (6) residents over 60 years old five (5) can be non-ambulatory one (1) bedridden in room #4. Hospice waiver approved for five (5). The facility is in a residential area, and it is a one-story family home. A tour of the single-story facility included the living room, kitchen, dining room, four (4) resident bedrooms, one (1) staff room, 2 bathrooms, front yard, backyard, attached garage.

LPA toured the facility and observed the following: Each resident’s bedroom has the required furniture and bedding. There is extra clean linen and towels in hallway cabinet. Smoke / carbon monoxide detectors were observed in each room and throughout the facility and are properly operating. The facility has one (1) fully charged fire extinguishers which is kept in kitchen. Cleaning supplies and toxic substances are inaccessible locked in cupboards in kitchen. Freezers are maintained at a temperature of 0-degree F and the refrigerators at a maximum of 40 degrees F. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. There are no firearms or weapons stored at the facility. The hot water temperature in the bathrooms were measured between the required range of 105-120 degrees F. Bathrooms had required grab bars and nonskid mats. The facility does not have a swimming pool or bodies of water on the premises There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. Garage has an extra refrigerator and supplies.

SEE LIC 809C

No deficiency was observed during today’s visit. Exit interview was conducted with Administrator Trice and a copy of report was provided.