Routine inspection·January 29, 2026

On 01/29/2026 at 12:30 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with , Laura and explained the purpose of the visit. The facility’s fire clearance was approved for capacity of 75 (seventy-five) residents. In which all may be non-ambulatory. Hospice waiver approved for 19 (nineteen) residents. Administrator Certificate #7008812740 expires 07/07/2027. LPA toured the facility with Tracey including but not limited to four (4) residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 74 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 114.2 and 116.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. LIC809-C Continued... LIC809-C (Page 2) LPA reviewed 6 (six) residents records. LPA reviewed 8 (eight) staff records and 8 of 8 have current first aid training and associated to the facility. Emergency Fire Drills were conducted 10/07/2025, 11/05/2025 and 12/04/2025 on all three (3) shifts. Elopement drills were conducted on 10/23/2025, 11/13/2025 and 12/19/2025. Food Service Report was reviewed dated 12/17/2025. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 02/05/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance - Reviewed No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.