KITCHEN: The LPA inspected the kitchen/food service area at 8:36 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 locked under the kitchen sink. Cleaning supplies and toxins were also observed under the kitchen sink locked and inaccessible to residents in care. At 8:40 a.m., the water temperature was tested in the kitchen faucet, and it measured 106.7 degrees Fahrenheit.

LIVING ROOM/DINING ROOM: At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed three residents watching television in the dining room during the inspection. The facility maintained a comfortable temperature. The LPA observed required postings throughout the common space.

(Report Continued on LIC 809C...)

GARAGE: The garage is kept locked at all times. The washer and dryer were observed in the garage. Detergents and cleaning solutions were observed locked and inaccessible to residents in care. The facility has emergency food and water which was observed to be in good condition.

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

BEDROOMS: There are three (3) resident bedrooms. One (1) bedroom is 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. The LPA observed a closet in the hallway with extra towels and linens. There is a staff room on premises on the second floor which is kept inaccessible to residents.

RESTROOMS: There are two (2) resident restrooms. The main bathroom is in the hallway and the second bathroom is in room #3. 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 all bathrooms; the first bathroom measured 111.5 degrees Fahrenheit at 8:43 a.m.; and the second bathroom measured 110.8 degrees Fahrenheit at 8:45 a.m.

RECORDS: Records review began at 08:59 a.m.; three (3) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms.

(Report Continued on LIC 809C...)

At 9:37 a.m., a review of Resident #2’s (R2’s) Physician Report, dated 06/22/2023, indicted R2 has no capacity for self-care. R2 is neither on hospice, nor does the facility have an exception request on file to admit or retain R2. The Administrator stated R2 is able to do many activities of daily living (ADL) without needing assistance. At 10:35 a.m., the LPA observed R2 going to the restroom on their own. The Administrator stated they will be contacting R2’s primary care physician (PCP) to re-evaluate R2 and update R2’s physician’s report to reflect correct information.

Five (5) personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were complete. The LPA also audited the current Administrator’s file, and it was in order.

The LPA conducted an interview with one (1) staff member at 11:05 a.m.

At the time of the visit, the LPA obtained the following documents: LIC 500 Personnel Report, LIC 9020 Client Roster, LIC 610 Emergency Disaster Drill, and a copy of the Liability Insurance.

MEDICATIONS: Medications review began at approximately 11:20 a.m.; medications are centrally stored and locked in a 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 medications review.

Exit interview conducted. No citations issued. A copy of the report was issued.