The Providence Manor

Type of visit: Required - 1 Year

On 7/18/2023 at 10:30 am, Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced required annual visit and was greeted by the Administrator. LPA Spaeth confirmed there are five non ambulatory residents with one bedridden and two Hospice residents. The facility is licensed as an RCFE to serve six residents of which six may be non-ambulatory and two may be bedridden. There is a hospice waiver Kitchen – LPA observed a seven-day supply of non-perishable food and a two day supply of perishable food items. At 9:55 am, LPA observed the cleaning supplies were securely locked underneath the kitchen sink and the knives were locked in a kitchen drawer. The medications are locked in a kitchen cabinet and LPA also observed the first aide kit. A fire extinguisher is also located in the kitchen area. Backyard – LPA Spaeth observed the delayed egress alarm leading out of the sliding glass door to the backyard was properly working. The backyard is a shaded area which contained comfortable seating. The side gate leading from the backyard to the front yard was not locked. Bedrooms – LPA Spaeth observed there are two residents living in the master bedroom. The delayed egress alarm leading from the bedroom to the backyard was properly working. The room contained bed, linens, night stand, and night lamp. LPA also observed the other three bedrooms also contained the required bed, linens, night stand and night lamp. The delayed egress alarm properly worked throughout the facility. Bathrooms – At 10:15 am, LPA tested the water temperature in the resident’s bathroom and LPA observed the reading was 106.7 degrees F. LPA Spaeth observed both bathrooms contained slip resistant mats, hand soap, paper towels, and trash can. Continued on 809-C Common Areas – LPA observed comfortable seating in the living room and family room. The dining area contained a dining room table and chairs. Smoke/Carbon Monoxide Detectors -The smoke detectors were tested at 10:50 am and were operable. The carbon monoxide detector was also operable. LPA reviewed residents’ files at 10:55 am until 11:19 am. LPA reviewed staff files at 11:20 am until 12:10 pm. LPA interviewed three resident at 1:15 pm until 1:40 pm and interviewed two staff members at 1:40 pm until 1:50 pm There are no deficiencies to report. Exit interview conducted, and a signed copy of the report was given to the Administrator.the state’s words, verbatim · CDSS document, Jul 18, 2023

Type of visit: Case Management - Other

LPA Spaeth conducted an unannounced visit and was greeted by two caregivers. LPA observed both caregivers were wearing masks. LPA also observed COVID signs on the front door. LPA's temperature was recorded and LPA answered the COVID questions. LPA stated the purpose of the visit was to do a case management inspection because the facility has residents and has been newly licensed. Caregivers confirmed there are four residents at the facility. LPA began the tour at 8:50 am and observed the sign in station at the front entrance. The living room contains comfortable furniture. The kitchen has wash your hands sign posted along with hand soap, paper towels and a trash can. The knives were locked in a kitchen drawer, cleaning supplies locked underneath the sink, and resident medications locked in a kitchen cabinet. LPA observed an adequate supply of perishable foods in the refrigerator and frozen meats in the freezer section of the refrigerator. The pantry was well organized and contained seven day supply of various canned goods. LPA observed the backyard contained comfortable seating and the side gate that leads from the back yard to the front yard was not locked. The egress doors were operational and the fire extinguisher was located in the kitchen. There are four bedrooms in the facility and all four residents were taking a nap after breakfast. The bathrooms contained wash your hands sign, hand soap, paper towels, non skid mats, and trash cans. The door leading to the garage was locked and LPA observed the washer dryer along with the laundry soap was also locked. LPA reviewed resident records and there are no issues to report at this time. There are no deficiencies to report at this time. Exit interview was conducted, appeal rights and a copy of the signed report was given tot the Administrator.the state’s words, verbatim · CDSS document, Sep 14, 2022

Type of visit: Prelicensing

LPA Spaeth arrived at the facility at 9:00 am and was greeted by the Administrator. LPA's temperature was recorded and LPA answered the COVID screening questions and signed in at the front entrance. The administrator confirmed there are four residents in the facility. LPA conducted the Comp III presentation with the Administrator from 9:05 am until 9:50 am.. LPA and the Administrator began the tour at 9:50 am. Upon entering the facility, LPA observed the living room/dining room combination. The living room contained comfortable seating and the dining room contained a dining room table with chairs. The room was spacious and clean. LPA entered the kitchen/family room combination and observed a five-day supply of fresh fruits and vegetables in the refrigerator. The freezer section contained frozen meats. LPA observed a seven-day supply of canned goods, pasta, and rice within the pantry. The cleaning supplies were locked underneath the sink and the knives are safely locked in a kitchen cabinet. LPA also observed the locked cabinet which contains the residents’ medications and the first aid kit. The family room contains comfortable seating and a television. A resident was enjoying an activity with a caregiver and another resident was sitting on the couch reading a magazine. LPA was then escorted outside and observed a covered patio with comfortable patio furniture. The side gate was unlocked that leads from the backyard to the front yard. LPA observed four resident rooms which all contained a bed, linens, chair, night stand, lamp, chest of drawers, and a closet. LPA observed the resident rooms each contained a doors which lead to the outside of the facility. The egress alarms were properly working throughout the facility. The staff room was locked. The hallway cabinets contained an adequate supply of linens, towels, and PPE supplies. LPA was escorted to the locked garage which contained the washer and dryer along with a locked cabinet where the laundry supplies are kept. LPA observed the two bathrooms which contained soap, paper towels, trash can, grab bars and slip resistant mats in the walk-in showers. The bathrooms were neat and clean. The water temperature was checked at 11:43 am and was 112.0 degrees F. At 11:45 am, the smoke and carbon monoxide detectors were checked and are working properly. LPA observed three fire extinguisher. There is a fire extinguisher in the kitchen, hallway, and garage. The Let Us Know signs as also posted within the facility. Upon LPA's conclusion of the tour, LPA did not observe any issues at this time. Exit interview was conducted, appeal rights discussed, and a copy of the report was given to the Executive Director.the state’s words, verbatim · CDSS document, Jun 10, 2022