At 1:43PM, the LPA, along with Licensees, 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:

KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit.

RESTROOMS: The LPA observed 3 (three) restrooms in the facility; one is a shared resident restroom, one is a private restroom, and one is a staff restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was tested in common hallway restroom at 01:44PM and measured at 118.0 degrees Fahrenheit, which is within the required range.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 6 (six) total bedrooms; 5 (five) are designated as resident rooms - 1 (one) shared and 4 (four) private and 1 (one) is designated as a staff room.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. A fireplace was noted to be covered and

Report Continued on LIC 809-C

The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The garage was observed locked and contained the laundry area, as well as emergency food supply, PPE supply, and storage.

Fire extinguishers were observed to be fully charged and last serviced on 07/15/2022. Hardwired combination smoke and carbon monoxide detectors were tested at 01:48PM and were functional at the time of the visit.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Licensees regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies cited. Exit interview conducted. A copy of the report was provided.