Beginning at 10:44AM, the LPA and Administrator 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. The following was observed:

LPA observed facility fire extinguisher to be fully charged and last serviced 06/27/2024. Hardwired combination smoke and carbon monoxide detectors were tested at 02:08PM and were functional at the time of the visit. No fire clearance concerns were observed.

KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer to the right of the stove. The supply of dishes is adequate. Appliances in the kitchen were clean and functional. The facility had a sufficient supply of two-day perishable and seven-day nonperishable food. Cleaning supplies were observed in a locked cabinet under the kitchen sink.

COMMON AREAS/GARAGE: The facility is a single-story structure with a large sunroom, dining room and living room. The LPA did not observe any obstructions or hazards. At the time of the visit, the living room, sunroom and dining room furniture were observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature throughout the visit. Linen closet and locked cabinet containing cleaning supplies and hygiene items was observed in the main hallway locked and inaccessible. The garage is located adjacent to the living room. Garage was observed to be locked and contained an extra refrigerator/freezer, emergency food and water, laundry area, and additional storage. Report Continued on LIC 809-C

RESTROOMS: The (2) two resident 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 in the common resident restroom was 116.5 degrees Fahrenheit, which is within the required range.

OUTDOOR AREA: The backyard has outdoor covered patio area equipped with furniture for resident use. There is are gates on both sides of the facility and were observed to be self-closing and latching. No bodies of water were noted.

RECORD REVIEW: At 11:20AM. a review of facility files was initiated. The LPA obtained a copy of the staff roster and liability insurance.

Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All 4 (four) of 4 (four) records observed were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All 3 (three) of 3 (three) staff files reviewed were in order.

MEDICATIONS: Medications review began at 01:40PM. Medications are centrally stored and locked in a mediation cabinet in the kitchen; medications are labeled and checked for expiration dates. LPA reviewed medications for 2 (two) residents. Medications observed were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control plan and Emergency Disaster plan. Both documents were observed to be complete and updated annually as required. The facility conducts disaster drills quarterly, with the last documented drill on 07/16/2024.

INTERVIEWS: During today's visit, LPA interviewed 1 resident and 3 staff. No concerns were noted.

No citations issued. Exit interview conducted. A copy of today's report was provided.