Routine inspection·July 2, 2025

A t 8:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the Administrator and LPA explained the reason for the visit. At 8:40am LPA conducted a tour of the physical plant and observed the following: The facility is licensed for capacity of six (6) residents. The fire clearance is approved for one (1) non-ambulatory in room #4 and two (2) non-ambulatory in room #5. The facility also has an approved hospice waivers for two (2). There are four (4) bedrooms designated for clients’ use, of which two (2) bedrooms are private, and two (2) bedrooms are shared. Bedrooms are appropriately furnished and have appropriate lighting. Live-in staff bedroom is located by the kitchen and kept locked at all times. Bathrooms have soap, paper towels and hand washing signs were observed. Extra towels and linens were readily available. The hot water temperature measured at 120.0°F. Facility maintains a temperature of 71°F. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. There are two (2) fire extinguishers at the facility. One (1) is located by the kitchen and the second (2) fire extinguisher is located in the living room. Both extinguishers were last serviced on 05/29/2025. The laundry is located in the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. All chemicals, detergents and medications are kept in the laundry room and inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested at 9:30am and observed to be functional. At 9:40am, LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Continue on LIC809-C LPA discussed the importance of maintaining care and supervision to meet the needs of residents. Between 10:00am to 11:00am, LPA reviewed records of four (4) residents and two (2) staff. Client and staff records appeared to be complete and updated. The annual fee is paid in full. LPA observed Administrator certificated renewed on 04/22/2024 with an expiration date of 04/22/2026. LPA collected the Certificate of Liability Insurance and LIC500. No citations were issued during this visit. Exit interview conducted and a copy of this report signed and delivered.