Beginning at 12:20PM, the LPA, along with Licensee/Administrator 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 extinguisher is fully charged and recently serviced. Carbon Monoxide detector was tested at 03:05PM. Smoke detectors were tested at 03:06PM. All were functional at the time of the visit.

BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated for resident use and one (1) 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 two (2) bathrooms for resident use. One (1) is designated for shared resident use and one (1) is a private 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 shared resident bathroom and measured in compliance with regulation.

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.

KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Knives are stored in a locked kitchen drawer. Medications are stored in a locked kitchen cabinet.

Report Continued on LIC 809-C

OUTDOOR SPACE: The backyard has a patio area with patio furniture including a table, chairs and umbrella for resident use. All passageways were observed to be clear. The facility has a pool, which was observed to be fenced and locked in compliance with regulation.

RECORD REVIEW: Began at 12:33PM. 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 three (3) staff files and six (6) resident files observed were in compliance with regulation. Administrator Certificate was observed to be expired, however LPA reviewed the Administrator Certification website, which indicated all documents were received 08/10/2023 and the Administrator's Certificate is still pending at this time. All trainings were observed to be complete.

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 10/31/2023. Emergency disaster plan was observed to be complete and updated annually, as required.

MEDICATION REVIEW: Began at 02:03PM. Medications for two (2) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit.

INTERVIEWS: During today's visit, LPA interviewed two (2) staff and two (2) residents.

No deficiencies cited. Exit interview conducted. A copy of today's report was provided.