Beginning at 10:35AM, the LPA along with Interim ED, 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. The following was observed:

5-Year fire sprinkler inspection was completed on 09/15/2023. No safety concerns were noted at that time. Fire extinguishers throughout the building were observed to be fully charged and last serviced on 09/15/2023.

MEMORY CARE: Memory Care is located on the first floor and has 18 (eighteen) rooms. Resident bedrooms are single and double occupancy with private bathrooms. A random sampling of 3 (three) resident rooms were observed to be furnished appropriately. Bathrooms were observed to be safe and sanitary with grab bars and non-skid mats. Hot water was measured in a sample of observed resident rooms and tested within the required range of 105 to 120 degrees Fahrenheit. Medications for the memory care unit are centrally stored and locked in the medication room. The indoor and outdoor areas of the memory unit are secured with a delayed egress system, which functioned properly during the visit. There are two outdoor gated courtyards designated for Memory Care. LPA observed sufficient outdoor furnishings and shaded outdoor space.

KITCHEN: The main kitchen and dining room are located on the 1st floor. Food is prepared in the main kitchen and delivered to the dining area and the Memory Care dining room. Facility dining room and commercial kitchen were inspected and found to be in compliance with Title 22 regulations. LPA observed

Report Continued on LIC 809-C

COMMON AREAS: The facility is a two story building. The facility contains multiple common areas, which were all observed to be clean, furnished appropriately and in good condition at the time of the visit. There were no obstructions and/or tripping hazards throughout the facility. All required postings were observed in the common areas on the first floor. Carbon monoxide detectors were tested throughout the building and all functioned properly.

The LPA and Interim ED toured the outside area of the Assisted Living, which contains 2 (two) courtyards for resident use. The LPA observed appropriate outdoor furniture, with a covered shaded area for residents.

RESIDENT ROOMS: There are 60 Assisted Living units and can be found on the first and second floors of the building. Assisted Living units are equipped with a refrigerator, sink, and microwave and contain private restrooms. A random selection of 7 (seven) resident rooms were observed. Residents rooms were observed to be furnished appropriately and contained appropriate bedding/linens. Bathrooms were observed to be safe and sanitary with grab bars and non-skid mats. Water temperature was checked in multiple randomly selected rooms in the Assisted Living unit and measured within the required range of 105 to 120 degrees Fahrenheit.

INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's Emergency Disaster Plan, which was observed to be complete and updated annually as required. Emergency Disaster drills are conducted monthly, with the last drill documented on 10/15/2023.

RECORD REVIEW: Will be completed during the annual continuation.

MEDICATIONS: Will be reviewed during the annual continuation.

INTERVIEWS: Throughout today's visit, LPA interviewed 4 (four) residents.

Exit interview conducted with Interim ED. Exit interview conducted. A copy of today's report was provided.