The LPA 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. This is a Residential Care Facility for the Elderly (RCFE). This facility is approved for a maximum capacity of forty-nine (49) non-ambulatory residents, of which forty-eight (48) may be bedridden. The facility has an approved hospice care waiver with the licensing agency for fifteen (15) residents.

The LPA inspected the food service area in the facility and observed that items which could constitute a danger to residents are kept inaccessible to residents. All appliances were in operable condition and looked clean/in good repair. Appliances such as microwaves, refrigerators, stoves, etc. are clean and operating properly. Food utensils, dishes, glasses, etc. are clean and in good repair with no cracks or chips. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. LPA observed an appropriate/adequate amount of perishable and non-perishable food items maintained in the facility. Furniture is room/resident appropriate, clean and in good repair. All rooms are appropriately furnished for their intended use such as bedrooms, common areas, etc. Hot water temperature is maintained between 105-120 degrees Fahrenheit as per Community Care Licensing (CCL) Title 22 regulations. Outdoor activity spaces have shaded areas and furnished for outdoor use. Each resident has an adult bed with a mattress, pad, bedsprings, and pillow, which are clean and in good repair. Each bed is fitted with sheets, pillowcase, blankets, and bedspread that are clean and in good repair. Each resident has adequate dresser and closet space for clothing and other belongings that includes at least two drawers or adequate dresser space. The facility has a sufficient supply of linens to permit weekly changing or more often to always ensure clean linens for residents. Equipment and supplies for resident personal hygiene is available and on site. Activity supplies are available for residents. As the facility has an approved fire clearance for a maximum forty-nine (49) residents, a signal system was observed by LPA and required by the Licensing Agency. Continued on 809-C

At the time of the visit, all common areas/interior rooms of the facility were observed to be appropriately furnished, with all furniture in good condition. The facility common areas include communal restrooms in the hallways, resident bedrooms, a resident activity room, locked laundry room, locked/staff only kitchen area, dining room, locked food storage/pantry, locked closet areas in the hallways containing the storage of clean linens, PPE materials, resident hygiene products, and activity materials. The facility also contains multiple staff offices and staff storage/break room. The LPA observed required postings throughout the common spaces including Resident Personal Rights and Contact information for Ombudsman as well as Licensing. There are activity supplies and equipment, including activity materials for the residents. All window screens were in good repair. There is appropriate lighting in the common areas of the facility. All passageways through the common areas of the facility were free of obstruction, and all inclines are well-lit with no stairwells/stairs for resident use. Carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were fully charged and serviced annually. The facility maintained a comfortable temperature in all areas inspected. LPA did not observe any noticeable outdoor hazards. Outdoor activity spaces in the facility are shaded and equipped with furniture for resident use. The facility has adequate storage of additional supplies/emergency supplies. The designated laundry area in the facility has appropriate storage of cleaning products, which are kept locked and inaccessible to residents. Emergency food and water in storage were observed to be in good condition by the LPA. Cleaning supplies, disinfectants, and other items that could pose a danger are kept in areas inaccessible to residents. Continued on 809-C

A continuation is needed for the annual required facility site inspection/evaluation as LPA did not have time to conduct record review of documentation maintained by the facility including personnel records and resident records. LPA was not able to conduct an audit of the centrally stored medications at the facility and during the continuation, a change of administrator process needs to be conducted as the listed administrator for this facility is not the current administrator in the facility.

Exit interview conducted by LPA. Copy of this report provided to the facility.