The facility has clearance for 6 non-ambulatory residents, 1 of which may be bedridden. The Bedridden resident must be housed in bedroom 1 or bedroom 2 of the facility. At the time of this annual inspection on 07/18/2023, there were no bedridden residents living in the facility. The facility has a hospice waiver for 4 residents. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a locked drawer in the kitchen. Kitchen appliances were in operable condition. The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food. Additional perishable food items were maintained on a shelf and/or an extra freezer. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation. The Kitchen/food service and preparation area was somewhat messy, but nothing to suggest any violation of any regulations and everything appeared to be in good/operating condition. The Kitchen are also serves as the storage area for Resident Records, Staff member records, Medication Administration Records (MARS), and the Centrally Stored Medications themselves. All of these documents and medications are stored in locked and secure cabinets away from perishable food items and kitchen utensils/kitchen microwave, oven, etc. The LPA observed the Licensee unlock each of these cabinets to show the secure nature of the sensitive materials.

Continued on 809-C

GARAGE/OUTSIDE: The backyard area has an indoor patio area/sun room equipped with furniture for resident use. There were no bodies of water noted. All exits from the facility are locked, which the LPA checked to make sure the locks were engaged. There is a separate laundry room where cleaning products are stored, which is kept locked. The laundry room is accessible through the garage where 2 staff rooms are also located. Cleaning supplies and disinfectants are kept in locked cabinets in the garage. In the front of the facility, the LPA noted that the outdoor front area of the facility was in a good state physically, with no signs of neglect or lack of maintenance.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are six designated resident rooms. All of the resident rooms have an individual bed for one resident. Each closet in all the resident rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for future residents.

RESTROOMS: The two resident restrooms were in the process of being cleaned and sanitized while the LPA toured the facility. Both restrooms were in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in both restrooms at the appropriate degrees Fahrenheit as per the regulations. Continued on 809-C

MEDICATIONS: Medications were reviewed in the Medication Administration Record (MARS) for each resident. Medications for all residents are in a centrally stored and locked cabinet in the kitchen. The LPA observed the Licensee demonstrate the locking and unlocking of the centrally stored medication cabinet. The LPA observed and audited the medications of residents, including bubble packs, powders, and liquids. All medications are labeled appropriately according to the pharmacy and physician. There were no signs of missed medications or medication irregularities according to the LPA upon the audit of the MARS and the actual medications.

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

FACILITY DOCUMENTATION: The facility keeps hard copies of the Application for an RCFE, Applicant Information, Designation of Facility Responsibility, LIC 500 Personnel Report, LIC 501 Personnel Record, LIC 503 Health Screening Reports, LIC 610E Emergency Disaster Plan for Residential Care Facilities For the Elderly, LIC 9282 Infection Control Plan, Fire Safety Clearance, and Facility Sketch. The facility has a Plan of Operation, Control of Property, Staff Job Descriptions, Personnel Policy, In-Service Training for Staff, Facility Program Description, Rules of Discipline/Personal Rights, Admission Agreement for Residents, Theft & Loss Policy, Neighborhood Complaint Policy, Hazard Assessment, and Job Description for the Administrator. The facility has a Dementia Care Plan document as well as Hospice Care Waiver. The Hospice Care Waiver states the maximum number of Hospice Patients is four (4). Continued on 809-C

Exit interview conducted. A copy of the report was issued.