KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and freezer were inspected. Food labels were inspected and checked for dates and expiration dates. Food had labels clearly marked with dates. Knives and sharps were observed locked in a staff room adjacent to the kitchen. Cleaning supplies and items that could pose a danger were secured in locked cabinet in the garage. The hot water temperature was measured at 118.2 F at 10:01 a.m. which is within the required range.

COMMON SPACES/ BACKYARD/ GARAGE: 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 appear to be in good condition. The fire extinguishers appeared to be fully charged and were last inspected 08/01/2024. The smoke and carbon monoxide detectors were tested at 10:49 a.m. and functioned properly during the visit. The last emergency disaster drill took place on 11/10/2024 and conducted quarterly. Activities were observed in the common areas. There is a washer and dryer on the premises. Laundry soap is stored in a locked cabinet above the laundry area in the garage. The facility has a sufficient supply of emergency food and water located in the garage. Cleaning supplies and items that could pose a danger were secured in locked cabinet in the garage. There is an open office which contains records that remain locked at all times in filing cabinets. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. (PAGE 1) Report Continued on LIC 809C 2nd page....

BEDROOMS: There are four (4) total bedrooms. Three (3) are designated as client bedrooms; All Three (3) are designated as shared double-occupancy bedrooms. One (1) is designated as a staff room which remains locked at all times. LPA observed all client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There was a linen closet in the hallway with extra towels and linens.

MEDICATIONS: Medications review began at approximately 12:20 p.m. The medications are locked in a cabinet adjacent to the kitchen near the backyard exit. Medications for two (2) clients were reviewed. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records.

RECORDS: PERSONNEL FILES: were reviewed beginning at 10:20 a.m. for three (3) staff including the Administrator. Files were reviewed for, but not limited to personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order at the time of the visit. CLIENT RECORDS: were reviewed beginning at 10:50 a.m. for two (2) clients. Files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All files were in order at the time of the visit. The LPA and staff discussed P&I Money at 12:02 p.m. The two (2) clients currently do not have the facility managing or safeguarding their cash resources. Clients handle their own finances and cash resources.

INTERVIEWS: One (1) staff interview was conducted. There were no clients available for interview during the inspection.

During today’s visit, the LPA obtained copies of the following: LIC 500 Personnel Report, LIC 9020 Resident Roster, and current liability insurance.

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