Graceful Living 2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 10:20am to conducted a 1 year annual visit to the facility above. LPA met Administrator Jennifer Lawrence and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan on file with the department. The facility has a sign in and out clipboard for visitors at entry in the garage area with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 06/01/2027. The facility is approved for a capacity of 6 Non- Ambulatory of which 2 may be bedridden in bedroom 1. Physical Plant & Environmental Safety: The facility is a 3 bedroom and 2 bathroom currently occupying 6 residents and employs 7 staff and 1 Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has dual smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage. The facility has a backyard and front yard for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Staffing: The facility employes 8 staff and 1 Administrator. Staff records are kept confidential. LPA reviewed 5 random staff files. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. All files were kept up to date with all requirements being met. Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed 5 staff training records for Initial and/or Annual Training Requirements of 20 plus hours meeting 8 hours of dementia training, 4 hours of hospice care, postural supports and restricted health condition and 8 hours of other training to include ADL's, resident characteristics, emergency preparedness policy and procedures, infection control requirements, PPE and Quarterly Disaster Drills. Staff handling medications had required medication training. Trainer met the requirements to train staff. Initial training was kept on file. Resident Rights Information: All required posting were posted at entry or in the common areas of the facility, License, Personal Rights, CCL and LTCO posters, PINS, Emergency Plan, Facility Sketch, theft and loss policy, Resident and Family council. Planned Activities: The facility has space inside and outside for visiting and activities. The facility has an activity calendar for activities thorough out the month. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical & Dental: The facility has a medication cabinets in the hallway that are kept locked. Facility provides transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected medication cupboards for all prescription and PRN medications with Doctors orders. No medications labels were altered, no medications were expired, and medications were all stored in original containers. The facility has a locked box in refrigerator for required medication and an ice chest with ice packs to keep cold for emergency use. The facility has a red sharps container for disposal of syringes. Continued 809-C Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Five files were reviewed for signed Admission Agreements, Medical Assessments as LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Pre-Admission appraisals are conducted on perspective residents before accepting them into care. The Facility does not handle cash resources for the residents in care. Facility does submit incident reports to the department when required. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and last inspected 04/8/2026. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not currently have residents with oxygen. The facility has 1 hospice residents in care. Hospice care plans are kept on file and up to date. The facility has 1 resident currently on Home Health services. Home Health services records are kept on file. The facility does not have delayed egress. LPA conducted interviews with 2 residents and 2 staff. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Aug 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 9:55am to conducted a 1 year annual visit to the facility above. LPA met Administrator Jennifer Lawrence and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan and provide plans to the department. The facility has a sign in and out clipboard for visitors at entry in the garage area with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Physical Plant & Environmental Safety: The facility is a 3 bedroom and 2 bathroom currently occupying 6 residents and employs 6 staff and 1 Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has dual smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a backyard and front yard for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 06/01/2024. The facility is approved for a capacity of 6 Non- Ambulatory of which 2 may be bedridden in bedroom 1. Staffing: The facility employes 8 staff and 1 Administrator. Staff records are kept confidential. LPA reviewed 5 random staff files. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. All files were kept up to date with all requirements being met. Personnel Records & Training: The facility keeps confidential files for each staff member. LPA reviewed 5 staff training records for Initial and/or Annual Training Requirements of 20 plus hours meeting 8 hours of dementia training, 4 hours of hospice care, postural supports and restricted health condition and 8 hours of other training to include ADL's, resident characteristics, emergency preparedness policy and procedures, infection control requirements, PPE and Quarterly Disaster Drills. Staff handling medications had required medication training. Trainer met the requirements to train staff. Initial training was kept on file. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Five files were reviewed for signed Admission Agreements, Medical Assessments, LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, Personal Rights, and Safeguard for personal property and valuables. Pre-Admission appraisals are conducted on perspective residents before accepting them into care. The Facility does not handle cash resources for the residents in care. Facility does submit incident reports to the department when required. Incidental Medical & Dental: The facility has a medication cabinets in the hallway that is kept locked. Facility provides transportation to medical and dental appointments when needed. The medications records were reviewed and all residents in care had a Medication Administration Record (MAR) and a Centrally Stored Medication Destruction Record (CSMDR). LPA inspected medication cupboards for all prescription and PRN medications and Doctors orders. No medications labels were altered. The facility has a locked box in refrigerator for required medication and an ice chest with ice packs to keep cold for emergency use. The facility has a red sharps container for disposal of syringes. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and last inspected 02/17/2025. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does not currently have residents with oxygen. The facility has 1 hospice residents in care. Hospice care plans are kept on file and up to date. The facility does not currently have any residents on Home Health services. Home Health services records are kept on file. The facility does not have delayed egress. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does not currently have residents with oxygen. The facility has 1 hospice residents in care. Hospice care plans are kept on file and up to date. The facility does not currently have any residents on Home Health services. Home Health services records are kept on file. The facility does not have delayed egress. LPA conducted interviews with 2 residents and 2 staff. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Aug 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Miller arrived at 10:24 a.m. to conduct a one-year annual visit to the facility above. LPA met with Administrator Jennifer Lawrence and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 3 shared bedrooms and 2 bathrooms. Facility currently occupies 6 residents and employs 5 full time staff, and one Administrator. LPA Miller was authorized to enter and inspect facility. The facility had a smoke and carbon monoxide detector that was tested and was working properly during visit. 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 secured 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. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and are locked in cabinet in garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use and umbrellas are used for shade. The facility has telephone and internet service for resident use. Operational Requirements: The facility has a current plan of operation on file with the department. The facility has current liability insurance and expires on 6/1/2025. The facility is approved for a capacity of six. The fire clearance is granted for 6 non-Ambulatory 2 of which may be bedridden. Continued 809-C Staffing: The facility currently employes 5 full time staff, and one Administrator. Staff files were reviewed. Current Administrator Certificate expires 11/18/2024. Personnel Records & Training: The facility keeps confidential files for each staff member. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. Staff have annual training completed for various subjects/topics and hours for 2023. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed five resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible. Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. LPA observed that food, snacks and drinks are available, when the residents want them. Cleaning solutions and equipment are stored separately from food supplies. Disaster Preparedness: The current emergency disaster forms were posted. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does currently has a resident receiving Home Health services. Exit door alarms are working. Exit interview conducted, copy of report provided.the state’s words, verbatim · CDSS document, Aug 20, 2024