KITCHEN: The LPA inspected the kitchen/food service area at 9:51 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. The knives and sharps are stored under the kitchen sink locked and inaccessible to residents in care. At 9:52 a.m., the water temperature was tested in the kitchen faucet, and it measured 116.2 degrees Fahrenheit.

COMMON AREAS: At the time of the visit, living room, family room, and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. At 10:03 a.m., the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit.

(Report Continued on LIC 809C...)

GARAGE: The washer and dryer were observed inside the garage. Detergents and cleaning supplies were observed in a locked cabinet inaccessible to resident in care. The facility has a sufficient amount of emergency food and water which was observed to be in good condition. The LPA observed a sufficient supply of Personal Protection Equipment (PPE).

BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There was one (1) gate that self-latches. No bodies of water were noted at the time of the visit.

BEDROOMS: There are four (4) resident bedrooms. Two (2) bedrooms are single occupancy, and two (2) bedrooms are double occupancy. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting.

RESTROOMS: There are two (2) resident restrooms. The first restroom is located in the hallway and the second restroom is located in bedroom #4. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in both bathrooms; the first bathroom measured 114.8 degrees Fahrenheit at 9:57 a.m.; and the second bathroom measured 118.0 degrees Fahrenheit at 10:01 a.m.

RECORDS: Records review began at 10:15 a.m.; six (6) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All resident records were in order.

(Report Continued on LIC 809C...)

The current Administrator’s file was also reviewed, and it was complete. The last emergency disaster drill took place on 10/08/2023.

At the time of the visit, the LPA obtained the following documents: LIC 500 Personnel Report, LIC9020 Client Roster, the emergency disaster plan, and a copy of the liability insurance.

MEDICATIONS: Medications review began at approximately 1:00 p.m.; medications are centrally stored and locked in a file cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

Exit interview conducted. A copy of the report was issued.