KITCHEN: The LPA inspected the kitchen/food service area at 8:50 p.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 markedThe knives and sharps stored in a locked cabinet in the kitchen. Cleaning supplies and disinfectants are stored under the kitchen sink inaccessible to residents.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed two residents having breakfast in the dining room during the inspection. The facility maintained a comfortable temperature. At 9:07 a.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were observed fully charged and last serviced on 3/15/2023.

(Report Continued on LIC 809...)

GARAGE/BACKYARD: The washer and dryer are in the garage. The garage is kept locked at all times. There is an additional refrigerator in the garage. The facility has emergency food and water which was observed to be in good condition. Cleaning supplies and toxins were observed locked and inaccessible to residents in care. The facility has at least a 30-day supply of Personal Protection Equipment (PPE). The backyard has a covered outdoor area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There is one gate that self-latches. No bodies of water noted at the time of the visit.

BEDROOMS: There are four (4) resident bedrooms. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There is a staff room on premises. The LPA observed a closet in the hallway with extra towels and linens.

RESTROOMS: There are two (2) resident restrooms. The first restroom is located in the hallway and the second restroom is located in bedroom #4. 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 both bathrooms and measured between 105- and 120-degrees Fahrenheit at the time of the visit.

RECORDS: Records review began at 9:21 a.m.; four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms.

At 10:27 a.m., record review of Resident #1’s (R1’s) file revealed R1’s Admissions Agreement was completed but missing R1’s signature. The Administrator will have R1’s Power of Attorney (POA) sign form.

(Report Continued on LIC 809C...)

The current Administrator’s file was also reviewed, and it was in order.

At the time of the visit, the LPA obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster, the emergency disaster plan, and a copy of the liability insurance.

MEDICATIONS: Medications review began at 12:55 p.m.; medications are centrally stored and locked in a cabinet inside 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. No errors observed during the medication review.

The LPA conducted interviews with three staff during the inspection.

Exit interview conducted. Report was reviewed and a copy was issued.