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 fourteen (14) Non-Ambulatory residents, of which two (2) may be bedridden. Bedridden residents are approved to be in bedrooms #1, #2, and #8 of the facility. The facility has an approved Hospice Waiver for seven (7) residents. The facility has been approved for a secured perimeter of electronically locked gates/fencing. The physical plant of the facility contains eight (8) resident bedrooms, and four (4) resident bathrooms, kitchen area, dining room/living room, library room, laundry room, and garage/storage area. There is an outside area of the facility for residents to utilize for outdoor activities and an outdoor patio area with furniture and shade.

KITCHEN: The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a locked drawer inaccessible to residents. 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). 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 residents are kept inaccessible to residents 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 all furniture in good condition. There is a fireplace in the facility, located in the dining area/living room that is covered an 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 multiple fire extinguishers that were fully charged and serviced annually, the last service being March 2023. This is a single-story facility with a main dining room/living room area, kitchen area, library room, laundry room, 8 resident bedrooms, 4 resident restrooms, a locked centrally stored medication containment area, extra storage areas for additional perishable food, cupboards 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.

OUTSIDE/LAUNDRY/MISCELLANEOUS: The exterior of the facility has an approved secured perimeter which consists of a metal fence around the entire facility with locked gates. The gates are locked through a combination of electronic punch numbered locks as well as traditional key locks. Inside of the locked perimeter is the outdoor/outside activity area for residents with a patio, furniture, shade, a small garden, and a fountain that currently is empty of water and filled with stones. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. The facility has an outdoor activity area that is provided with a shaded area and furnished for outdoor use. There is a body of water noted on the facility property which is a small water collection reservoir inaccessible to residents as it is outside of the locked perimeter fence. The designated laundry area is where cleaning products are stored, which are kept locked and inaccessible to residents. The laundry room is accessible through the interior hallway of the facility as a specific area which has all hazardous items locked with key locks. Staff members are the only individuals allowed to do laundry and the entire room is kept locked at all times. 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 (8) designated resident rooms in the facility with either 1 resident per bedroom or shared bedrooms with 2 residents per bedroom. The bedrooms have storage areas for clean linens, towels, pillows, etc. Each resident’s bedroom has a single bed, 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: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There are four (4) resident bathrooms in the facility. All restrooms 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. Nightlights are installed in the hallways outside of the resident restrooms. The facility maintains both communal restrooms for residents in the hallways of the facility, as well as a personal restroom for residents in a shared bedroom.

RECORDS: The facility keeps confidential storage of resident records as well as Staff member records on-site at the facility. Staff member records were reviewed for, but not limited to Personnel records, Health assessments with Tuberculosis (TB) test results, Personnel Action Notice, Job Description with date of employment, Employee Rights, Criminal record Statements/Criminal record clearances, first aid/CPR certification that is not expired, and the appropriate training. All staff members’ personnel records had the appropriate documentation with no expiration of any training. Continued on 809-C

MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. Centrally Stored Medications are in a locked room that has a combination electronic lock on the door, which remains locked at all times, inaccessible/locked to residents. The locked room with the centrally stored medications is off of the dining room/living room area of the facility, in between the kitchen and dining room area. 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.

FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exit plans with necessary telephone numbers. The facility keeps hard copies of facility documentation such as LIC 500 Personnel Report, Emergency Disaster Plan for Residential Care Facilities for the Elderly (RCFE), Infection Control Plan, and a Facility Sketch. Provider Information Notices are easily accessible and 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.