Cloe and Erica's Board & Care

Type of visit: Required - 1 Year

At 7:45am on 09/16/2025, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the facility annual inspection. LPA met with facility Administrator, Alan Flojo, announced who he is and the reason for the visit, Administrator and LPA conducted a physical tour of the facility. This facility has eight bedroom, 3 bathroom, kitchen, two main living areas, larger outdoor covered patio with shade from pergola, and three locked storage sheds. There are six single occupancy resident rooms and two bathrooms for resident use. The other two bedrooms and bath room is designated for staff use. LPA tested water temperature throughout the facility and found to be in regulation range of 105*-120*(f).The facility has smoke and carbon monoxide detectors tested and working properly during visit. LAP noted that the facility has working fire extinguisher and it is primed in the green as good. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectants, cleaning solutions and poisons are inaccessible to residents in locked in cabinets. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced side yard and backyard for client use with a pergola for shade. The facility has a telephone and internet service for residents’ use. LPA noted that there are at least 2 days of perishable foods and at least 7 days of nonperishable foods on hand for all residents and staff. LPA noted that the medications are stored and locked in a cabinet in the back hallway. LPA also conducted a staff and resident file review. LPA reviewed the facilities plan of operation that addressed dementia training and bedridden residents. LPA reviewed both the emergency disaster plan and infection control plan to be updated. LPA conducted a full review of the care tools modules. At this time there are no violations or citations as a result of the facility annual inspection. Exit interview, report read, and report provided.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Required - 1 Year

On 10/25/2024, Licensing Program Analyst (LPA) Brian Phillips arrived at the facility above to conduct an unannounced evaluation visit. When the LPA arrived, they were greeted by Administrator Alan Flojo. LPA informed facility representatives of the reason for the visit upon entry. 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 six (6) non-ambulatory residents. The facility has an approved hospice care waiver for four (4) residents in care. The LPA inspected the food service areas in the facility and observed that knives/sharp instruments are stored in locked drawers 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. Furniture is room/resident appropriate, clean and in good repair. All rooms are appropriately furnished for their intended use such as bedrooms, dining rooms, kitchens, living rooms, 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 insure 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 six (6) residents, there is no signal system required or observed by LPA. Refrigerators and freezers are maintained at an appropriate temperature Fahrenheit as per CCL regulations. Food storage and preparation areas are clean and appropriate for food preparation. Continued on 809-C The food service areas are clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. A single locked storage area for central storage of medications was observed by LPA, in the hallway of the facility. Cleaning supplies are kept in areas separate from where food supplies are stored. Walls, ceilings, floors, carpeting, window screens, and areas around the facility are clean, painted and/or in good repair. There are locked storage area(s) for poisons, toxic, cleaning solutions, disinfectants, etc. Fire extinguishers and smoke detectors operate properly. Doors and passageways are unobstructed. There are no pools/bodies of water on the physical plant of the facility as observed by LPA. During the inspection, LPA did not observe any firearms that would require trigger locks, locked and inaccessible, or firing pins removed. 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. There is a fireplace on the premises, which is covered and inaccessible to residents. Carbon monoxide detectors were operational at the time of the visit. The fire extinguisher was fully charged and serviced annually. The LPA observed required postings throughout the common spaces including Resident Personal Rights and Contact information for Ombudsman as well as Licensing. The facility maintained a comfortable temperature in all areas inspected. There is appropriate lighting in all the common areas of the facility. All passageways through the common areas of the facility were free of obstruction with all changes in incline having accessibility ramps. All window screens were in good repair. 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. Vehicles used to transport residents are in safe operating condition with appropriate insurance information. The facility has auditory alarm/alert systems on delayed egress entrances/exits. Electronic devices are in place to monitor exits of the facility, if exiting presents a hazard to any resident. The facility restrooms were sanitized and in operating condition while the LPA toured the facility. All restrooms in the facility were sufficiently stocked with soap, paper towels, required postings, and clean trashcans with closed lids. Continued on 809-C Towels and washcloths are not shared by residents in the facility. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per Title 22 regulations between 105-120 degrees Fahrenheit. There are an adequate number of toilets per residents in the facility. Nightlights are installed as observed by LPA. All toilets and hand washing areas are maintained in safe and sanitary operating condition. Additional equipment, aids, and/or conveniences are available accommodate any physically handicapped residents who need such items. The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Each resident bedroom has a bed, nightstands, and lights and nightstand lamps to provide sufficient lighting. Each closet in all the resident rooms can store or has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. The resident bedrooms are big enough for all beds, furniture, and any resident assisting device a resident might need such as a wheelchair or a walker. Each room has sufficient lighting for each resident. The facility has provisioned to each resident of furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. An emergency exiting plan and emergency phone numbers are posted in an appropriate place. First-aid supplies, which include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual, are maintained. Administrator’s records, employees and resident records are maintained at the facility and available for review by the LPA as employees are hired and residents accepted into the facility. The facility complies with CCL standards for health screening, TB clearance, staff training, criminal background clearance and transfer requests. Admission agreements and needs and services (ANS) plan are maintained for each resident and/or their authorized representative. Resident records are maintained on the facility premises in a secured area. Centrally stored medications are locked in secure locked cabinet(s) inaccessible to residents. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. The facility administrator meets the qualifications as specified in Title 22 regulations. Provider Information Notices are available and able to be presented to Staff, residents, visitors, and accessible to LPA upon request during the inspection process. Prior to this facility evaluation visit, the facility was cited by LPA on 05/15/2024 for deficiencies regarding failure to maintain the auditory devices to utilize delayed egress devices on exterior doors and failure to adhere to Licensing agency reporting requirements regarding incident reports. All deficiencies been corrected at the time of this visit by LPA with prior proof of correction evidenced by LPA. Exit interview conducted by LPA. Copy of this report provided to the facility.the state’s words, verbatim · CDSS document, Oct 25, 2024

Allegation investigated: Resident eloped from facility due to improper supervision

On 05/15/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit to the facility above to issue final findings. LPA arrived at the facility, met with Licensee/Administrator Alan Flojo, and announced the purpose of the visit. On the allegation: Resident eloped from facility due to improper supervision. It is alleged that Resident #1 (R1) was not properly supervised by facility staff during an evening at the facility, which led to R1 wandering away from the facility through the front door. The allegation states R1 was seen by a neighboring homeowner sitting on their front lawn, which led the neighbor to call law enforcement. R1 was brought back to the facility by law enforcement, but according to the allegation the facility was dark with law enforcement knocking and ringing the doorbell several times before any Staff member came to the door. Allegedly the facility front door was not locked, and the alarm was not set. The allegation states no facility staff member was aware R1 had eloped. Continued on 9099-C Substantiated One night prior to R1’s elopement from the facility, R1 had a fall in the facility causing head trauma and requiring R1 to be observed in the hospital overnight. R1 sustained a hematoma and concussion from the fall. The hospital cleared R1 to leave the next day; and R1 was brought back to the facility the day of the elopement. According to the allegation, the facility was informed of the injury and stated that R1 would be properly supervised, including additional supervision due to the head injury from the fall. However, this supervision did not occur and R1 eloped from the facility due to improper supervision. On 04/11/2024, Licensing Program Analyst (LPA) Brian Phillips conducted a complaint investigation visit to the facility above. During this visit, the LPA toured the physical plant areas inside and outside that included the observation of the common areas of the facility as well as the individual resident bedroom areas of the facility. LPA observed that most resident bedrooms in the facility contain a front bedroom door as well as a separate door/sliding door to the exterior of the facility. The doors exiting the interior of the facility are monitored by an auditory alarm system in place that alerts Staff members with a loud noise when a door exiting the facility has been opened. These auditory alarm system(s) are located on every door that exits the interior of the facility into the outdoor areas/out of the facility. The auditory alarm system(s) consist of an electronic plastic/metal box and/or device approximately the size of a telephone that are attached to each door at eye level. The auditory alarm system(s) are powered by batteries which need to be changed monthly according to Staff interviews by LPA. This auditory alarm system is in place on the front door of the facility which exits the facility into the front yard and street. The bedroom of Resident #1 (R1) did have an auditory alarm system in place attached to the sliding door exiting R1’s bedroom into the backyard at the time of the allegation. On 04/11/2024, during the complaint investigation visit, LPA interviewed Staff members about the auditory alarm system(s) in place on doors exiting the facility to outdoor areas, and the monitoring of residents at night in the facility. According to Staff member interviews, the auditory door alarms/alert systems on each exit door out of the facility are battery powered which need monthly maintenance to change the batteries. Without the changing of batteries in the auditory alarm systems monthly, the noise emitted when an exit door is opened could be very faint or potentially nonexistent. Staff members interviewed by LPA stated that the batteries are changed monthly in the actual auditory alert system situated on each doorway out of the facility. Continued on 9099-C However, the Licensee/Administrator informed LPA that the complaint allegation occurred almost exactly a month after the batteries were changed and that the auditory alarms could have been muffled or faint due to the circumstance of the batteries needing to be replaced at the time of the elopement by R1. The Licensee/Administrator was not present at the time of the elopement by R1 and is the only Staff member that oversees changing the batteries in the auditory alarm system(s) on doors exiting the facility. All Staff members interviewed by LPA denied that Staff members scheduled for overnight supervision of residents clock out or go to sleep on duty. All Staff members interviewed by LPA denied that the facility needs to be "shut down" early at night because of residents with dementia related conditions including sundowning. LPA interviewed Staff members of the facility about the facility response to the incident occurring the night prior to the elopement allegation in which R1 fell and suffered a head injury. LPA was told that after R1 was discharged from the hospital with a bad concussion, Staff were informed and knew that R1 required extra surveillance/monitoring due to the hematoma and concussion in addition to R1’s preexisting medical diagnosis. During interview with LPA, the Licensee/Administrator stated that the batteries in the auditory alarm system may have died/run out of charge causing the auditory alarm to be lowered or nonexistent. Staff members interviewed by LPA denied that the facility was totally dark with no movement inside and no responses to multiple knocks on the front door and ringing of the doorbell when Law Enforcement brought back R1 from the elopement. However, Staff members interviewed by LPA stated that they did not know if the door had been forgotten to be locked or the auditory alarm put on the evening of the elopement by R1. Staff members stated to LPA that sometimes if the battery in the auditory alarm system is low, then the sound of an exit door from the interior of the facility being opened can be very faint. Staff members interviewed by LPA stated that they did not know of any Staff member using their on-duty shift to sleep instead of providing supervision to residents. However, through Staff interviews, LPA learned that several Staff members work/live at the facility in a converted garage/Staff bedroom. LPA asked about the schedule of Staff members living in the converted garage and was told that there are Staff members who work during the morning and daytime so they can sleep at night, as well as Staff members with overnight schedule(s) which involved evening and nighttime supervision of clients. LPA corroborated this information through record review of the facility LIC 500 Personnel Report dated 04/11/2024 which specified the days and hours on duty for each individual Staff member of the facility. According to Staff interviews by LPA, there are employees who live in the converted garage/Staff bedroom with an employment schedule daily from morning until afternoon or early evening. Continued on 9099-C Staff members interviewed by LPA stated that these Staff members could be asleep at night in the Staff bedroom/converted garage and would hear it if a resident attempted to open a door out of the facility because of the auditory alarm system. During the 04/11/2024 complaint investigation visit, LPA requested and received relevant documents from the facility that would be pertinent to the investigation. LPA received the following information/documentation from the facility pertinent to the complaint allegations regarding residents in care: Release of Resident medical information, Identification and Emergency Information, Decisions about medical treatment, physician’s notes for resident, Resident Appraisals, Statements of Patient Advocates or Ombudsman, Physician Orders for Residents including Primary & Secondary diagnosis, Advance Health Care Directives, Appraisal Needs & Services Plans, Physicians Reports for Residential Care Facilities For the Elderly (RCFE), Tuberculosis (TB) Screening Results, Pharmacy Delivery Notes, and Emergency Department Patient Discharge Instructions. LPA received the Centrally Stored Medication and Destruction Record kept by the facility for resident(s) in care. The Physician’s Report for R1 dated 03/15/2023 indicated that R1 had a diagnosis of Dementia with a mental condition that included confusion/disorientation and wandering behavior. However, this Physician’s Report also indicated R1 was able to follow directions and was not able to leave the facility unassisted/without assistance. R1’s Preplacement Appraisal Information dated 03/21/2023 indicated a mental condition of mild Dementia but was able to walk without any physical assistance and was labeled as non-Ambulatory due to Dementia limitations. The facility kept a document which detailed the daily care/services for R1. On this document there is a section labeled “Overnight Shift” which states that R1 needs bedtime medications at 8:00pm and usually goes to bed around 9:30pm-10:00pm. According to the complaint allegation as well as the Law Enforcement report from the elopement of R1, the neighbor called Law Enforcement at approximately 7:00pm at night after seeing R1 sitting on their lawn. Based on the information obtained, there was Sufficient evidence to prove the allegation. Therefore, the allegation is deemed Substantiated at this time. Exit interview conducted, a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 15, 2024 · control 29-AS-20240408135431

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: May 16, 2024

87468.2 Add’l Personal Rights of Residents in Privately Operated Facilities (a)…residents in privately operated residential care facilities for the elderly shall have...personal rights: (4) Care, supervision, services by staff sufficient in numbers, qualifications, competency to meet needs. This requirement was not met based on interviews and record review; licensee did not comply with section cited above when Staff failed to change the batteries to maintain the auditory devices to monitor facility exits which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: Licensee agrees to calendar a schedule for the change of batteries in auditory alarm systems. Licensee agrees to test and make sure auditory alarm systems are working as intended to a satisfactory manner. Licensee agrees to schedule an all Staff training on Overnight Supervision of Residents in care.

Type of visit: Case Management - Deficiencies

On 05/15/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced Case Management-Deficiencies visit. LPA arrived at the facility, met with Licensee/Administrator Alan Flojo, and announced the purpose of the visit. On 03/07/2024, a resident fainted while at the facility, and fell causing head trauma. The resident went to the hospital overnight and was diagnosed with a sustained hematoma and concussion. The hospital cleared the resident to leave the next day; the resident returned to the facility on 03/08/2024. On 03/08/2024, the same resident wandered away/eloped from the facility through the front door. A neighbor down the street saw the resident sitting on their front lawn and called law enforcement. The resident was returned to the facility after the elopement by law enforcement on 03/08/2024. For both incidents, the licensing agency did not receive any incident reports or any telephone communication from the facility. On 04/11/2024, LPA interviewed Staff members as well as the Licensee/Administrator about the lack of received Incident Reports to the licensing agency regarding either the incident on 03/07/2024 or 03/08/2024 occurring in the facility. The Licensee/Administrator stated that there were no Incident Reports submitted to Licensing for either the 03/07/2024 incident or the 03/08/2024 incident occurring in the facility. The facility will be cited for deficiencies regarding Reporting Requirements to the licensing agency. Exit interview conducted, a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 15, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jun 15, 2024

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require…(1) A written report submitted to licensing agency…within seven days...(D) Any incident that threatens welfare, safety or health of any resident This requirement was not met based on interviews and record review; licensee did not comply with section cited above when Staff Failed to notify Licenisng Department regarding a resident fall and elopement which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: Licensee agrees to submit Incident Reports to the Licensing Agency regarding any incident that threatens the welfare, safety, or health of any resident. LIcensing has already started to receive regular incident reports from the facility as of the Case Management-Deficiences visit by the LPA.

Type of visit: Required - 1 Year

On 10/12/2023, Licensing Program Analyst (LPA) Brian Phillips arrived at the facility unannounced to conduct an Annual facility Site Inspection Visit. LPA met with Administrator/Licensee Alan Flojo, and announced the purpose of the visit. 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) consisting of 8 bedrooms, (6 designated resident single rooms, 2 staff rooms) 3 restrooms, a kitchen, dining room, 2 living rooms, 1 Central Medication area (where medications are centrally stored and locked), laundry room, Staff office area, and multiple storage room areas. This facility is approved for a maximum of six (6) non-ambulatory residents, and has a hospice waiver for four (4) residents. KITCHEN: The LPA inspected the kitchen/food service area and observed that knives/sharp instruments are stored in locked drawers inaccessible to residents. Kitchen appliances were in operable condition and looked clean/in good repair. The LPA observed perishable items in good condition, with proper expiration dates precluding the perishable items from expiring. The facility has a sufficient supply of perishable and non-perishable food, which would last over a week (7 days). Additional perishable food items were maintained in storage area in the garage of the facility as well as in extra refrigerator and extra freezer located in the garage of the facility. The hot water temperature was measured in the kitchen at an appropriate temperature as per the regulation between 105-120 degrees Fahrenheit. Items that could constitute a danger to residents are kept inaccessible to residents in the kitchen area. The kitchen was clean and sanitary, with covered trashcans and operating ventilation systems. No toxic substances are stored in any food preparation or storage area, and all cleaning supplies for the kitchen are kept in a separate area than the food supplies. The freezer and refrigerator were both in the appropriate temperate Fahrenheit. There is enough tableware and utensils for all residents living in the facility, and enough equipment for the storage, preparation, and service of food. The facility cooks meals for the residents on a regular basis. COMMON AREAS: At the time of the visit, the common areas of the facility (dining room, 2 common room areas) were observed to be appropriately furnished, with all furniture in good condition. Contd. on 809-C There is a fireplace in the living room, which is covered and inaccessible. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were fully charged and are serviced annually. The facility is a 1 story home with 3 resident bedrooms, staff rooms, dining room, living room, storage room, kitchen, and laundry area/game room garage constituting the interior of the facility. 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. As the facility has 6 residents total with a capacity for 6 residents total so there is no signal system in place. There is a Staff Office area in between the kitchen and the dining room of the facility. This area contains a desk, computer, chair, and is the area where the Centrally Stored Medications are kept locked and inaccessible to residents. There is a grand piano in the common room area that is kept in good condition as well as a grandfather clock well maintained. OUTSIDE/LAUNDRY/MISCELLANEOUS: The front outdoor area of the facility consists of concrete steps and an open porch with tables and chairs. The front of the facility is contained by a stone/concrete wall with a gate that remains unlocked. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Outdoor activity spaces are completely enclosed by a fence and gates or walls. Outdoor activity spaces in the backyard are equipped with furniture for resident use including a patio with an umbrella for shade. All outdoor areas with stairways, inclines, ramps, or open porches have accessibility ramps for residents, and are well-lit. There were no bodies of water noted. A laundry room is located off the backyard of the facility and contains both the laundry area, and additional supplies/emergency supplies. The designated laundry area is where cleaning products are stored, which are kept locked and inaccessible to residents. There was emergency food and water in storage areas of the facility which was observed to be in good condition. Cleaning supplies, disinfectants, and other items that could pose a danger to residents are kept in areas inaccessible to residents. There is a first aid kit that includes sterile dressings, bandages, thermometers, scissors, tweezers, and a first aid manual. The vehicles used to transport residents are in safe operating condition with appropriate insurance information. LPA noted that outside in the back yard is completely enclosed by two gates on either side of the facility and has appropriate furniture for residents as well as shade. LPA did not observe any noticeable outdoor hazards. There are two (2) locked sheds in the backyard of the facility which contain tools, gardening supplies, and maintenance materials inspected. Contd 809-C BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are 6 designated individual resident rooms in the facility, and 2 bedrooms for Staff members of the facility. Hallways contain storage area for clean linens, towels, pillows, etc. Each resident bedroom has a single bed, night stands, and lights and night stand lamps to provide sufficient lighting. Each closet in all the resident rooms has extra pillows, clean/fresh linens, and appropriate incontinence materials if applicable for any resident. The resident bedrooms are big enough for all beds, furniture, and any resident assisting device a resident might need such as a wheelchair or a walker. Each room has sufficient lighting for each resident. RESTROOMS: The facility restrooms were sanitized and in operating condition while the LPA toured the facility. There are 3 shared resident bathrooms in the facility. 1 resident bathroom is located in the master bedroom area of the facility, and the other resident bathrooms are next to the dining room and common areas of the facility. All restrooms inspected had assisting equipment for residents including grab bars and/or non-skid surfaces. The bathrooms were sufficiently stocked with soap, paper towels, and additional supplies; towels and washcloths are not shared. The hot water temperature was measured in the restrooms at the appropriate degrees Fahrenheit as per the regulations between 105-120 degrees. As the facility only contains 6 residents at the time of inspection, there is at least 1 toilet and sink for each 3 residents, and at least 1 bathtub/shower for each 3 residents. Nightlights are installed in the hallways outside of the common area restrooms. RECORDS: The facility keeps confidential storage of personnel records and resident records on-site at the facility. Personnel records reviews were reviewed for, but not limited to Personnel records, Health assessments with Tuberculosis (TB) test results, Personnel Action Notice, Job Description with date of employment, Employee Rights, Criminal record Statements/Criminal record clearances, first aid/CPR certification that is not expired, and the appropriate training. All staff member personnel records had the appropriate documentation with no expiration of any training. Resident records were reviewed for Pre-Admission/Placement appraisals, Physicians Reports, Consent Forms, Personal Rights for Residents, Emergency Information, Release of Medical Information, Needs and Services Plan (ANS), Resident Assessments, Self-management of medications if applicable, Medication Orders, and Medication Logs. All resident records reviewed by the LPA had the appropriate documentation with no missing or incomplete information. Continued on 809-C MEDICATIONS: The facility maintains a locked centralized storage area for resident medications. The LPA observed the centrally stored medications as well as the Centrally Stored Medication and Destruction Record. Centrally Stored Medications are in a locked cabinet off the kitchen/Staff office area/common area resident living room but inaccessible to residents. LPA audited the medications for residents and noticed no irregularities or issues concerning the dispensing of medications or the logging of medications. The medications in the facility were labeled appropriately with no additional or prohibited markings by the facility. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening and a sanitation station. The staff members will keep up signs that promote good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection 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. FACILITY DOCUMENTATION: There are required postings throughout the facility, including emergency exiting plans with necessary telephone numbers. The facility has copies of the Application for an RCFE, Applicant Information, Designation of Facility Responsibility, Affidavit Regarding Client/Resident Cash Resources, Surety Bond, Personnel Report, Personnel Record, Health Screening Report, Emergency Disaster Plan for Adult Residential Facilities, Residential Infection Control Plan, Facility Sketch, Plan of Operation, Control of Property, The Job Description for Each Staff Position, Personnel Policy, In-Service Training for Staff, Facility Program Description, Rules of Discipline/Personal Rights, Admission Agreement for Residents, Theft & Loss Policy, and Job Description for the Administrator. This facility is approved for a maximum of six (6) non-ambulatory residents, and has a hospice waiver for four (4) residents. No deficiencies cited. Exit interview conducted. A copy of the report was issued to the Administrator of the facility.the state’s words, verbatim · CDSS document, Oct 12, 2023