At 10:55 AM, the LPA initiated a walk-through of the facility, accompanied by the administrator.

At 10:51 AM, the LPA inspected the kitchen and found it clean, with no food preparation or cooking in progress at the time. LPA checked the appliances and observed them in working order. The locked cabinet containing knives and the locked cabinet under the sink with soap and cleaning supplies were also inspected. LPA inspected the refrigerator and pantry cabinets and observed enough supplies of fresh perishable food for (2) days and nonperishable staples for (7) days. No expired food and no stored medications were noticed.

At 10:58 AM, LPA inspected the dining area next to the kitchen and found it clean. There were 2 bar stools, a dining table, and dining chairs to accommodate all the residents.

At 11:03 AM, LPA inspected the living room, and observed it clean, with all the furniture in good repair. There was a set of couches, chairs, ottoman, desk, and computer station in the living room.

At 11:07 AM, the LPA inspected the fire extinguisher mounted on the wall next to entrance door and found it was fully charged with a last service tag of 01/29/2024. The administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit.

Continued on LIC 809-C

At 11:20 AM, LPA inspected both bathrooms and found them clean, sanitary, and in good working condition. It contained soap, grab bars, paper towels, a trash can, and non-slip flooring shower with shower curtain. The hot water temperature at the sink faucet was measured at 107.8°F in bathroom #1 and 107.4°F in bathroom #2.

At 11:26 AM, the LPA inspected the storage space in the hallway and observed it containing clean linens and towels for residents’ use and found it well organized

At 11:28 AM, LPA toured the backyard area. The backyard has a set of a patio table, chairs, and an umbrella for resident use. Ramps were observed in good condition with no blocking/tripping hazards. There were no bodies of water noted and was found clear of obstructions.

At 11:35 AM, the LPA inspected the first aid kit and observed it fully stocked.

At 11:37 AM, the LPA reviewed Emergency Drill Logs and observed drills are conducted quarterly, with the most recent drill completed on 11/5/2024.

At 11:39 AM, The LPA reviewed (5) staff personnel records and (5) resident records. The LPA observed that 5 of 5 clients had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. LPA observed that 5 of 5 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 5 of 5 staff members are associated with the facility.

At 11:48 AM, the LPA observed a locked centrally stored medication cabinet located in the hallway next to dining/kitchen. Medications were organized in separate bins for each resident. All medication bottles were properly labeled. Centrally Stored Medication Records (CSMR) were reviewed and found to be complete.

No deficiencies were cited during today's visit.

An exit interview was conducted. A copy of this report was left with the Administrator, Marylou Williams, whose signature on this form confirms receipt of the report.