According to the facility’s license, the facility has a maximum capacity of one hundred and twenty (120) residents ages 60 and above, all of whom may be non-ambulatory; twenty of who may be bedridden. Hospice waiver approved for thirty (30) residents. Approved for delayed egress for building B only. During today’s inspection, there were a total of fifty four (54) residents in care. This facility does not feature a secured perimeter there are delayed egress doors in building B.

LPA, accompanied by Administrator and the Business Office Manager, toured the interior and exterior of the facility, and inspected multiple rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was 77 F. Hot water temperature at taps accessible to residents were all compliant: Kitchen sink was 121 F, Bathroom #1 sink was 120 F, and Laundry sink was 121 F.

Refrigerator temperature was 32 F and freezer temperature was -2 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas.

[CONTINUED ON LIC 809C]

No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPAs interviewed staff and residents. LPA reviewed multiple staff and resident records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Administrator Susan Sorensen, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.