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 Residential Facility (ARF), with an approved fire clearance capacity of four (4) clients. The facility is approved for two (2) ambulatory clients and two (2) non-ambulatory clients.

The LPA inspected the food service area in the facility and observed that items which could constitute a danger to clients are kept inaccessible to clients. All appliances were in operable condition and looked clean/in good repair. Appliances such as microwaves, refrigerators, stoves, etc. are clean and operating properly. Food utensils, dishes, glasses, etc. are clean and in good repair with no cracks or chips. There is enough tableware and utensils for all clients living in the facility, and enough equipment for the storage, preparation, and service of food. LPA observed an appropriate/adequate amount of perishable and non-perishable food items maintained in the facility. Furniture is room/client appropriate, but some furniture needed to be cleaned and the physical plant of the facility was observed by LPA to be messy/cluttered. All rooms are appropriately furnished for their intended use such as bedrooms, common areas, etc. Hot water temperature is maintained between 105-120 degrees Fahrenheit as per Community Care Licensing (CCL) Title 22 regulations. Outdoor activity spaces have shaded areas and furnished for outdoor use. Each client has an adult bed with a mattress, pad, bedsprings, and pillow, which are clean and in good repair. Each bed is fitted with sheets, pillowcase, blankets, and bedspread that are clean and in good repair. Each client has adequate dresser and closet space for clothing and other belongings that includes at least two drawers or adequate dresser space. The facility has a sufficient supply of linens to permit weekly changing or more often to always ensure clean linens for clients. Equipment and supplies for client personal hygiene is available and on site. Activity supplies are available for clients. Continued on 809-C

The facility contains a live-in staff room that always remains locked, inaccessible to clients. The facility contains an outside area for clients to utilize for outdoor activities/outdoor visitations and an outdoor patio/gazebo area with furniture and shade. At the time of the visit, all common areas/interior rooms of the facility were observed to be appropriately furnished, with all furniture in good condition. 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. All window screens were in good repair. There is appropriate lighting in the common areas of the facility, and lighting that needed maintenance/repair was addressed by administrator during LPA visit. All passageways through the common areas of the facility were free of obstruction, and all inclines are well-lit with no stairwells/stairs for client use. Carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were fully charged and serviced annually. The facility maintained a comfortable temperature in all areas inspected. LPA did not observe any noticeable outdoor hazards. Outdoor activity spaces in the facility are shaded and equipped with furniture for client use. The facility has adequate storage of additional supplies/emergency supplies. The designated laundry area in the facility has appropriate storage of cleaning products, which are kept locked and inaccessible to clients. Emergency food and water in storage were observed to be in good condition by the LPA.

The facility restrooms were sanitized and in operating condition while the LPA toured the facility. All restrooms in the facility were sufficiently stocked with soap, paper towels, required postings, and clean trashcans with closed lids. Towels and washcloths are not shared by clients in the facility. Contd. on 809-C

An emergency exiting plan and emergency phone numbers are posted in an appropriate place. First-aid supplies, which include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual, are maintained. Administrator’s records, employees and client records are maintained at the facility and available for review by the LPA as employees are hired and clients accepted into the facility. The facility complies with CCL standards for health screening, TB clearance, staff training, criminal background clearance and transfer requests. Admission agreements and needs and services (ANS) plan are maintained for each client and/or their authorized representative. Client records are maintained on the facility premises in a secured area. Centrally stored medications are locked inaccessible to clients. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. The facility administrator meets the qualifications as specified in Title 22 regulations with a pending renewal ARF administrator certificate application received on 07/07/2023. Provider Information Notices are available and able to be presented to Staff, clients, visitors, and accessible to LPA upon request during the inspection process.

During this inspection/evaluation process, LPA observed the physical plant of the facility to appear cluttered/messy which did not raise to the level of a citation/deficiency, but was discussed with facility administrator. LPA also observed a ceiling light in a client bedroom which needed to be replaced and was in the process of being corrected by the facility administrator at the time of the visit by LPA.

Exit interview conducted by LPA. Copy of this report provided to the facility.