Kitchen: The kitchen/food area was observed at 9:43 a.m. The hot water temperature was measured at 113.2 degrees Fahrenheit at 9:45 a.m. The facility has a sufficient supply of non-perishable and perishable food items. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. At 9:44 a.m., the LPA observed a butter knife on the kitchen counter. The Administrator locked item immediately. The knives and sharps are kept in a locked drawer.

Living Room / Dining Room: Living room and dining room furniture was observed to be in good condition, and the lighting was adequate. The facility maintained a comfortable temperature. At 9:49 a.m., the smoke detector(s) and carbon monoxide detector were tested and were operational. The fire extinguisher was observed to be fully charged on . There is a functioning telephone on the premises.

(Report Continued on LIC 809C...)

Backyard: The backyard has a covered outdoor area equipped with furniture for client use. The LPA observed one side gate that is self-closing and latched. Passageways were observed clear of obstructions in case of an emergency. No bodies of water were noted at the time of the visit.

Restrooms: The two client restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in both bathrooms. The first bathroom measured 109.7 degrees Fahrenheit at 9:39 a.m.; and the second bathroom measured at 109.2 degrees Fahrenheit at 9:42

Bedrooms: There are four (4) client bedrooms. Two (2) bedrooms and single occupancy, and two (2) bedrooms are double occupancy. All four bedrooms were furnished with appropriate linens and required furniture. Adequate lighting in all bedrooms was observed. The LPA observed a closet by the hallway with additional linens for client use.

Records: The LPA reviewed staff records at 10:04 a.m. and client records at 10:30 a.m. and the LPA reviewed five (5) client files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. All client files were in order.

The LPA reviewed three (3) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification and yearly training. All files were complete.

(Report Continued on LIC 809C...)

The facility is vendored by Tri-Counties Regional Center (TCRC) as a level 2-i home. The last disaster drill was conducted on 10/19/2023.

At the time of the visit, the LPA obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster, and LIC 610 Emergency Disaster Drill.

Medications: Medications review began at approximately 12:00 p.m.; medications are centrally stored and locked in a file cabinet adjacent to the living room. All medications including PRNs were labeled, stored, and locked inaccessible to clients. 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.

No deficiencies were noted at this time. Exit interview conducted. Report was reviewed and a copy was issued.