The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. This is an Adult Day Program Facility approved for clients of an age range of 18 years and older. The facility is approved for up to 30 ambulatory clients, 5 of which may be non-ambulatory.

KITCHEN: The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in the kitchen are inaccessible to clients. This consists of a locked cafeteria style kitchen, which is a separate indoor room connected to the main living room area. The kitchen is accessible for employees by two doors with a viewing window in between, having a pull-down shutter. During the Adult Day Program hours when clients are in the facility, the two doors to the kitchen are locked and the shutter is opened, allowing clients to observe the kitchen area, but making the sharp instruments, heating elements, and cleaning materials inaccessible to clients. The administrator demonstrated this to the LPA, which was observed by the LPA. 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. Additional perishable food items were maintained on a shelf and/or a freezer. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation. 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: At the time of the visit, all indoor common areas of the facility appeared to be in good condition through observation of the LPA, with all furniture in good condition. 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(s) were tested and operational at the time of the visit. The fire extinguishers were fully charged and were serviced annually. The LPA observed required postings throughout the common space including Client Personal Rights and Ombudsman information. There are activity supplies and equipment, including reading materials for the clients. 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, with the facility having no indoor stairways needing to be well-lit or have sturdy hand railings/accessibility devices. This is a single-story facility that has 14 current clients, with a capacity for 30. The indoor areas of the facility consist of a main entrance into the living room/activity area, a kitchen, a long hallway with restrooms, and a back exit into an enclosed outdoor backyard/activity area.

BACKYARD/OUTDOOR ACTIVITY AREA/ETC.: The backyard/outdoor activity area of the facility is completely enclosed by a metal gate/fence with unlocked latches and gates. There is a side gate from the facility which is not delayed egress self-closing, but all clients are supervised by staff when they are in the outdoor activity area. The backyard of the facility is equipped with furniture for resident use including shaded tables, chairs, as well as a swing set and playground equipment (slide, etc.). There were no bodies of water noted. The backyard has a door into the main living room/common area of the facility as well as doors leading to the administrator’s office and staff member areas inaccessible to the clients. There is no designated laundry room and no storage of laundry related cleaning products as this is an Adult Day Program with no laundry service as per the facility Adult Day Program Plan of Operation. There was emergency food and water in a storage room/area which was observed to be in good condition. Cleaning supplies, disinfectants, and other items that could pose a danger to residents 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. This facility does not use vehicles in safe operating condition to transport clients per the facility Plan of Operation as this is an Adult Day Program. Continued on 809-C

RESTROOMS: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There is 1 male restroom and 1 female restroom in the indoor hallway of the facility. All restrooms inspected 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. There is no need for nightlights having to be installed in the hallways outside of the common area restrooms as this is an Adult Day Program facility with operating hours between 8:30am-4:00pm for clients.

RECORDS: The facility keeps confidential storage of personnel records and client records on-site at the facility. Personnel records reviews 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 documentation. All staff member personnel records had the appropriate documentation with no expiration of any training. The Adult Day Program facility client records were reviewed for Pre-Admission/Placement appraisals, Admission Agreements, Physicians Reports, Consent Forms, Personal Rights for Residents, Emergency Information, Release of Medical Information, Needs and Services Plan (ANS)/Individual Program Plan (IPP), Resident 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 does not maintain a locked centralized storage area for resident medications as per the Adult Day Program facility plan of operation. The clients attending the Adult Day Program facility daily have their medications logged and charted from their residence and bring their medication daily with a required/charted schedule for each client’s required medications. The facility keeps records of the medications needed by each client, including name/dosage/time/purpose as well as Medication Orders, Physician notes, and Medical/Health screenings. Continued on 809-C

FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exiting plans with necessary telephone numbers. The facility keeps hard copies of LIC 500 Personnel Report, LIC 501 Personnel Record, LIC 610D Emergency Disaster Plan for Adult Day Programs, LIC 9283 Infection Control Plan for Adult Day facilities, and LIC 999 Facility Sketch. The facility has a current fire inspection and fire clearance granted by the Fire Department.

The administrator of the facility informed the LPA that the facility is in the application process for a change of location to move the facility from the current inspected location to another building within the same general area. This Change of Location License application was in an ongoing status at the time of the Annual Facility inspection by the LPA.

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