KITCHEN: The LPAs began the inspection in the kitchen/food service area. Knives are stored in a locked box in the kitchen. Kitchen appliances were in operable condition. The LPA observed perishable items in good condition and the facility has a sufficient supply of perishable and non-perishable food. Additional perishable food items were purchased during the visit. The hot water temperature was measured in the kitchen within the designated regulatory degrees.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The hardwood floor around the dining room table appeared to be scuffed/scratched, but this did not present a hazard to any individual in the facility. There is a fireplace in the living room, which is covered and inaccessible. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. However, one smoke detector/carbon monoxide detector needed a new battery and beeped on a regular basis. The administrator informed the LPA that this would be corrected within the same day or the next day (06/23/2023). The administrator also showed the LPA a recently purchased new fire alarm/carbon monoxide detector as a precautionary measure. Due to the height of the ceiling where the fire alarm/carbon monoxide detector is located, a ladder is required to make any corrections. During the visit by the LPA, the administrator changed the battery in the fire alarm/carbon monoxide detector. This was then tested by the LPA and provided adequate warning/worked correctly. The fire extinguisher was fully charged and were last serviced 07/21/2022. All exits had required posting and were operational at the time of the visit. The LPA observed required instructional and regulatory postings throughout the common space. Continued on 809-C

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four designated resident rooms, with three in use by individual residents. At the time of the visit, the facility does not have a designated staff room. There was a linen closet in the hallway with extra towels and linens.

RESTROOMS: The resident restroom was clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathroom was sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in the common hallway restroom at the appropriate regulatory degrees Fahrenheit.

RECORDS: Resident records review began after the physical plant inspection.; three (3) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All records were in order. Personnel records reviews were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. No staff files had any missing information or expired CPR/First Aid. The facility conducts regular earthquake drills annually.

MEDICATIONS: Medication audit/review began after the record review for both residents and staff members. The medications are centrally stored and locked in a closet in the hallway. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record.

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes 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. The facility’s policies and procedures as it pertains to infection control are adequate. Contd. on LIC809-C

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