Routine inspection·September 17, 2025

On 9/17/2025 at 9:45 AM, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced annual 1-year required inspection. LPA met with Administrator Evangeline Lekse and explained the purpose of the visit. The administrator currently holds a certificate (#7007428740) that expires on 03/08/2027. The facility’s fire clearance was approved for six (6) residents, six (6) may be non-ambulatory with an approved hospice waiver for two (2) residents. LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of seven (7) total bedrooms which six (6) bedrooms are occupied by the residents and one (1) bedroom is occupied by staff. The facility consists of four (4) bathrooms, two (2) of which are shared resident bathrooms and two (2) private resident bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 75 degrees Fahrenheit. LPAs observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the facilities kitchen was measured at 123.1 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for residents. Smoke detectors and carbon monoxide combination were in operating condition during visit. Continued on LIC809C. Fire extinguisher was last purchased on 9/3/2025. First aid kit was observed to be complete. LPA reviewed six (6) staff and six (6) resident records. LPA reviewed a sample of medication. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 9/24/2025: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan - Reviewed Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.