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 an Adult Residential Facility (ARF), with an approved fire clearance capacity for six (6) developmentally disabled clients. The facility fire clearance approves six (6) ambulatory clients only. The physical plant of the facility contains three (3) client bedrooms, three (3) client restrooms (2 with toilet and bathtub/shower and 1 with only toilet), kitchen, dining room, living room, and laundry room/garage. There is an outside area of the facility that contains a large covered gazebo for clients to utilize for outdoor activities with furniture and shade.

KITCHEN: The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a drawer without a lock which the LPA stated to the Administrator was needed for the storage of sharp instruments to prevent client injury. This drawer that stores knives/sharp instruments is in a location of the facility that is inaccessible to clients, but still requires a lock to prevent any possible injury to client as kitchen knives/sharp instruments can be "dangerous weapons." Licensee immediately made corrections to provide lock on the kitchen knives/sharp instruments drawer and provided photographic evidence to LPA. Kitchen appliances were in operable condition and 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). Additional perishable food items were maintained in a storage area in the garage of the facility as well as an extra refrigerator and extra freezer located in the garage of the facility. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation between 105-120 degrees Fahrenheit. Items that could constitute a danger to clients are kept inaccessible to clients in the kitchen area. The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. Continued on 809-C

COMMON AREAS: At the time of the visit, the common areas of the facility were observed to be appropriately furnished, with no furniture in a deteriorating condition. There is one fireplace in the facility that is covered and inaccessible to clients. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector(s) were tested and operational at the time of the visit. The facility has a fire extinguisher that is fully charged and was last serviced in December 2023. This is a two-story family home, with the facility maintained on the first story of the building only. Clients are not allowed on the second floor of the facility. The facility interior consists of a lounge room area, play room area/dining room, kitchen, client bedrooms, client bathrooms, a staff bedroom, multiple closets/storage areas, a laundry room, and a garage/storage area. The facility maintains a locked centrally stored medication containment area off of the dining room area for clients. The LPA observed required postings throughout the common spaces including Client Personal Rights and Contact information for Ombudsman as well as Licensing. There are activity supplies and equipment, including activity materials for the clients 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 ramps over all changes in incline for client use.

OUTSIDE/LAUNDRY/MISCELLANEOUS: The front outdoor area of the facility consists of a walkway around a front lawn into the front door. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Outdoor activity spaces are completely enclosed by a wooden fence and gates. The facility has an outdoor activity area that is provided with a shaded area and furnished for outdoor use. There were no bodies of water noted. LPA noted that the back of the facility is completely enclosed by two gates on either side of the facility which is inaccessible to clients. The outdoor areas accessible to clients designed for client use in the backyard consists of a large gazebo with shade and furniture as well as a grass area with outdoor play equipment. Outdoor areas for client use have appropriate furniture for clients. LPA did not observe any noticeable outdoor hazards in areas accessible to clients. Continued on 809-C

BEDROOMS: The LPA observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are three (3) designated client rooms in the facility with all client bedrooms being shared, having two (2) clients per bedroom. The bedrooms have storage areas for clean linens, towels, pillows, etc. Each client bedroom has two single beds, nightstands, and lights/nightstand lamps to provide sufficient lighting. Each closet in all the client rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any client. The client bedrooms are big enough for all beds, furniture, and any client assistive device a client might need such as a wheelchair or a walker. Each room has sufficient lighting for each client. There is also one (1) Staff bedroom in the interior of the facility with a single bed only for Staff member use.

RESTROOMS: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There are three (3) client bathrooms in the facility. Two (2) of the client bathrooms contain a toilet as well as a bathtub/shower area, while one (1) of the bathrooms is a toilet area only with no shower/bathtub area. All restrooms inspected had assistive equipment for clients 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. Nightlights are installed in the hallways outside of the client restrooms.

RECORDS: The facility keeps confidential storage of client records as well as Staff member records on-site at the facility. Continued on 809-C

MEDICATIONS: The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. Centrally Stored Medications are in a locked cabinet that is specifically designated for clients, inaccessible/locked to clients. The locked cabinet has a keylock which can be unlocked and opened with a key held by Staff. This locked cabinet is off of the dining room area for clients within the facility. LPA audited the medications for clients 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.

FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility maintains pertinent documentation such as LIC 500 Personnel Report, LIC 501 Personnel Record, LIC 610D Emergency Disaster Plan for Adult Residential Facilities, LIC 9282 Adult Residential Infection Control Plan, and LIC 999 Facility Sketch. All documents were presented to LPA upon request during the inspection process.

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