Routine inspection·September 16, 2025

On 9/16/2025 at approximately 09:45 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. The Administrator, Monina Miller arrived shortly after to assist with today’s visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 12:00 PM and the following was noted: The facility is a single-story building with five (5) bedrooms and three (3) bathrooms. The facility is located a part of a two (2) acre lot with a total of three (3) buildings. The main house for residential use was observed to be within the west wing which was observed to be located behind the main building. The facility is currently occupying five (5) residents. There is no designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for four (4). Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 77°F. LPA observed a fire extinguisher to be located alongside the hallway’s passageway and dated 04/16/2025. LPA observed required postings such as Long-Term Care Ombudsman, See/Say Something, and Personal Rights to be located throughout the common areas. A working telephone was observed. Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. (continued on LIC 809-C) Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. The main building was observed to contain the following: LPA observed the main building to be equipped with laundry room, kitchen, staff office, common area and a variety of vacant rooms. LPA observed the vacant rooms to be used for storage purposes such as clothing and liens. Kitchen: The kitchen was observed to be located in the main building separate from the residential housing. LPA observed the kitchen to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. Laundry Room: The laundry appliances were observed to located within the main building. LPA observed cleaning solutions and toxins stored appropriately within the laundry room and inaccessible to residents. The laundry appliances were observed to be working and in proper condition. Garage: LPA observed there to be no garage within the premises. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. LPA observed there to be a three (3) locked sheds and one (1) locked storage unit, all inaccessible to residents. There is no body of water located at the facility. Medications: The medications along with staff and residents’ files were observed to be kept locked in the staff office. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer and First-Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. (continued on LIC 809-C) Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. There were no immediate health and safety hazards observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Administrator.