The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. This is a Residential Care Facility for the Elderly (RCFE), with an approved fire clearance capacity of Six (6) residents. Of the approved residents in care at the facility, Five (5) may be Non-Ambulatory and One (1) may be Ambulatory. The residents have an age range of sixty (60) years of age and older. The facility has an approved Hospice Waiver for One (1) Resident. The physical plant of the facility consists of a main entrance, kitchen, living room, garage with laundry room area, three (3) resident restrooms, four (4) resident bedrooms, and multiple indoor storage closets. The facility contains an outside area for residents to utilize for outdoor activities/outdoor visitations and an outdoor patio area with furniture and shade.

KITCHEN: The facility maintains one (1) main kitchen room/area for the facility. The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a locked drawer inaccessible to residents in the garage of the facility. Kitchen appliances were in operable condition and looked clean/in good repair. 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, which would last over a week (7 days). The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation between 105-120 degrees Fahrenheit (111 degrees Fahrenheit). Items that could constitute a danger to residents are kept inaccessible to residents outside of the kitchen area. The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. Continued on 809-C

COMMON AREAS: The indoor areas of the facility consists of resident bedrooms, restrooms, shower areas, a Centrally Stored Medication area, kitchen, dining room, storage area closets/rooms, living room, and a central lobby/entrance area upon entry into the facility. At the time of the visit, the common areas of the facility were observed to be appropriately furnished, with all furniture in good condition. There is one (1) fireplace in the facility, which is appropriately screened and inaccessible to residents. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector(s) were operational at the time of the visit. The facility has a fire extinguisher that was fully charged and serviced annually, being tagged as serviced in February 2024. This facility contains a dining room, four (4) resident restrooms, three (3) resident shower/bathing rooms, living room area, kitchen area, laundry room area in the garage, a locked centrally stored medication containment area, extra storage areas for additional perishable food, closets/rooms in the hallways of the facility containing extra linen/bedsheets/pillows, and storage areas for resident personal hygiene equipment constituting the interior areas of the facility. The LPA observed required postings throughout the common spaces including Resident Personal Rights and Contact information for Ombudsman as well as Licensing. There are activity supplies and equipment, including activity materials for the residents such as television, puzzles, games, etc. All window screens were in good repair. There is appropriate lighting in the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all inclines are well-lit with no stairwells/stairs for resident use. The laundry area for the facility is located in the garage of the facility that is inaccessible to residents. There is a main entrance walkway into the facility and an administrative entrance area for visitors. The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors, and walls are in good repair.

OUTSIDE/LAUNDRY/MISCELLANEOUS: The front outdoor area of the facility consists of cement walkways and grass areas. The facility outdoor front yard area is paved with a walkway up to the front door of the facility. The front yard has a patio with shade and outdoor furniture conducive for outdoor visitation. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The exterior of the facility has a closed perimeter which consists of a fence around the backyard area of the facility. Inside of the perimeter is the outdoor/outside activity area for residents with a patio in the backyard, furniture, shade. Contd. on 809-C

BEDROOMS: The facility has four (4) resident bedrooms, both individual bedrooms for one (1) resident and shared bedrooms for two (2) residents. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. The bedrooms have storage areas for clean linens, towels, pillows, etc. Each resident’s bedroom has a single bed or beds, nightstand, and lights/nightstand lamps to provide sufficient lighting. Each closet in all the resident rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. The resident bedrooms are big enough for all beds, furniture, and any resident assistive device a resident might need such as a wheelchair or a walker. Each room has sufficient lighting for each resident.

RESTROOMS: There are three (3) resident restrooms in the facility. The facility restrooms were sanitized and in operating condition while the LPA toured the facility. All restrooms/showers inspected had assistive equipment for residents including grab bars and/or non-skid surfaces. The restrooms were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per the regulations between 105-120 degrees Fahrenheit (108 degrees Fahrenheit). Nightlights are installed in the hallways outside of the resident restrooms. The facility maintains private, personal restrooms as well as a communal restroom for residents in care. All resident restrooms consist of a sink and toilet, while the resident shower/bathing areas consist of a shower and/or bathing area with grab bars and non-skid surfaces.

RECORDS: The facility keeps confidential storage of both resident and Staff member records on-site at the facility. Continued on 809-C

MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. Centrally Stored Medications are in a locked storage containment area within a cabinet in the kitchen area of the facility, which is located in the Main building of the facility. The medication room remains locked at all times, inaccessible/locked to residents. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record, The Medication Administration Record, and the record of Controlled Medications. LPA audited the medications for residents and noticed no irregularities or issues concerning the dispensing of medications or the logging of medications. The medications in the facility were labeled appropriately with no additional or prohibited markings by the facility.

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will 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. Continued on 809-C

No deficiencies cited. Exit interview conducted. A copy of the report was issued to the facility.