Beginning at 01:32PM, the LPA, along with facility staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

Fire extinguishers are fully charged and purchased on 07/25/2023. Hardwired smoke detectors were tested at 01:54PM and separate carbon monoxide detector was tested at 01:53PM; all were functional during today's visit. No fire clearance concerns were observed during today's visit.

BEDROOMS: There are 6 (six) total bedrooms in the facility; 5 (five) bedrooms are designated for resident use and 1 (one) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

BATHROOMS: There are 3 (three) bathrooms for resident use; 2 are designated as private resident restrooms and 1 (one) is a common restroom. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in 2 (two) resident bathrooms, both measured within the required range.

KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and other sharps were observed to be stored locked in a kitchen drawer. Cleaning supplies were stored in a locked cabinet

Report Continued on LIC 809-C

GARAGE: Garage was observed locked and contained laundry area, cleaning chemicals, extra food, supplies, and emergency food and water.

OUTDOOR SPACE: The backyard has a patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water on the premises.

COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit.

RECORD REVIEW/MEDICATION REVIEW: Began at 01:55PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All 2 (two) staff files and 5 (five) resident files observed were in compliance with regulation. Medications were reviewed beginning at 02:49PM. 2 (two) residents' medications were observed. All medications observed were labeled, stored, and properly documented at the time of the visit.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last drill conducted on 10/22/2023. Emergency disaster plan was observed to be complete and updated annually, as required.

INTERVIEWS: During today's visit, LPA conducted staff interviews and attempted resident interviews.

LPA requested a copy of the facility's liability insurance as well as current personnel report be sent via email.

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