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 of four (4) developmentally disabled adults aged 18-59 years old. The facility contains an outside area for clients to utilize for outdoor activities/outdoor visitations and an outdoor patio area with furniture and shade.

KITCHEN: The facility maintains a kitchen within the interior of the facility. The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in a locked drawer inaccessible to clients. 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 a locked cabinet in the kitchen area of the facility as well as an extra refrigerator and extra freezer located in a locked room/addendum off of the hallway 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. 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. The freezer and refrigerator were both the appropriate temperate Fahrenheit for the storage of food and prevention of spoiling. There is enough tableware and utensils for all clients living in the facility, and enough equipment for the storage, preparation, and service of food. Continued on 809-C

OUTSIDE/LAUNDRY/MISCELLANEOUS: The front outdoor area of the facility consists of a cement walkway around a front lawn, with a patio area in the backyard of the facility. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Outdoor activity spaces are completely enclosed by a fence and gates or walls. 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. There is a shed in the backyard of the facility that is unlocked and contains storage materials that would not constitute a danger to clients. The designated laundry area is where cleaning products are stored, which are kept locked and inaccessible to clients. The laundry area is accessible through the common area of the facility as a specific room off the main dining room/kitchen area. Laundry products such as toxic chemicals etc. are locked in cabinets in the laundry room area of the facility. There are emergency food and water in the garage which was observed to be in good condition. Cleaning supplies, disinfectants, and other items that could pose a danger to clients are kept in areas inaccessible to clients. There is a first aid kit that includes sterile dressings, bandages, thermometers, scissors, tweezers, and a first aid manual. The vehicles used to transport clients are in safe operating condition with appropriate insurance information. LPA noted that outside in the back yard is completely enclosed by two gates on either side of the facility and has appropriate furniture for clients as well as shade. LPA did not observe any noticeable outdoor hazards. Continued on 809-C

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. 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. Two (2) of the restrooms contain showers for clients. Nightlights are installed in the hallways outside of both the client restrooms.

RECORDS: The facility keeps confidential storage of Staff member records held off-site at a centralized office location for all facilities under the Licensee. 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. Client records were reviewed for Pre-Admission/Placement appraisals, Physicians Reports, Consent Forms, Personal Rights for Clients, Emergency Information, Release of Medical Information, Needs and Services Plan (ANS) and/or Individual Program Plan (IPP), Client Assessments, Self-management of medications if applicable, Medication Orders, and Medication Logs. All client records reviewed by the LPA had the appropriate documentation with no missing or incomplete information.

MEDICATIONS: The facility maintains a locked centralized storage area for client 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, inaccessible/locked to clients. This locked cabinet is an addendum/area in between the kitchen/dining room area and the laundry room area. Continued on 809-C

This required annual 1-year facility site inspection visit will need a continuation visit to conclude the aspects of the visit constrained by time limitations.

No deficiencies cited during this Annual Facility Inspection visit. Exit interview conducted. A copy of the report was issued to the facility.