Routine inspection·June 26, 2025

On 06/26/25, 10:00 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced annual inspection visit to the facility. LPA met with the Administrator and reason for the visit was discussed. Facility is licensed as a single-story residence, six (6) non-Ambulatory, of which, three (3) may be bedridden. Hospice waiver for six (6). Facility has six (6) private resident bedrooms and four (4) bathrooms. At 10:15 am, LPA conducted a tour of the physical plant with the Administrator and observed the following: Physical plant was inspected for cleanliness and condition . Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other necessary signage are posted in the bathroom and throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 76.0°F. , within the required range. Side door is located west of house which exits to the back yard. An approved Mitigation and Infection Control plan is on file. Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 5/25/2025 . Fire Detection/Protection system is present at facility. Multiple smoke/carbon monoxide detectors are installed, hardwired and interconnected. Detectors were tested and function properly. Two (2) fire extinguishers, located in Kitchen and Hallway, are fully charged, with inspection service date: 03/04/2025. [LIC 9099-C] Continued- KITCHEN area is clean and clear of clutter. LPA observed refrigerator, microwave, stove/oven, dishwasher and sink to be operational. Knives/Sharps are stored in a locked top kitchen drawer inaccessible to residents. Plates, cups, utensils, and two-day supply of perishable food is properly stored and labeled. A seven day supply of nonperishable food is located in detached garage and properly stored. Dish Soap, cleaning solutions, and toxins are stored in locked lower cabinet underneath the kitchen sink. Medications are stored in a secured medications cart in dining room area and are inaccessible to residents. A First Aid kit is accessible and stored in a dining room area cabinet. Medications are listed in centrally stored medication cart and destruction record log. Laundry area is located and secured in hallway storage compartment near the kitchen. Laundry soaps and other cleaning agents are stored and inaccessible to residents. Linen storage observed to have adequate supply of linen and towels. Bedrooms are observed as clean with sufficient lighting, properly furnished with bedding, linens, at least one chair, and night stand. Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 113.5°F. Within the required range. Garage is detached from house and observed to be locked and inaccessible to residents. Garage is also used as storage for water, PPE supplies, etc. Outdoor (backyard) area observed to have a shaded patio, with table, and sufficient seating for residents and visitors. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered; there are no bodies of water in the facility. Resident records: LPA observed records stored in a locked and secured hallway closet, inaccessible to residents. Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be current and complete. [LIC 9099-C] Continued- Staff records: LPA observed records stored in a locked and secured hallway closet, inaccessible to residents. Criminal record clearances were present, and Staff are associated to this facility. Staff records appear to be complete and current. There were no health and safety hazards observed during the inspection. Exit interview conducted and a copy of this report was given.