Routine inspection·June 27, 2025

On Friday, 06/27/25, 8:30 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced annual inspection visit at the facility. LPA met with the Administrator, and reason for the visit was discussed. Facility is licensed as a single-story residence, fire clearance for ten (10) non-ambulatory, and one (1) bedridden. Hospice waiver for eleven (11). Facility has eight (8) total bedrooms. Facility has two (2) bathrooms. At 8:50 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. Auditory alarm sensors are present on all exits. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 75.0°F ., within the required range. An approved Mitigation and Infection Control plan is on file. Hand washing, coughing etiquette, and other necessary signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted in April 2025. [LIC 9099-C]-Continued Kitchen area is clean and free of clutter. LPA observed refrigerator, microwave, stove/oven, dishwasher and sink to be operational. Knives/Sharps are stored in a locked kitchen drawer which is 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 kept in detached garage and properly stored. Dish Soap, cleaning solutions, and toxins are stored in locked lower cabinet underneath the kitchen sink. Fire Detection/Protection system is present in the facility. Multiple dual smoke\ carbon monoxide detectors are installed, hardwired, and interconnected. Detectors were tested and function properly. LPA observed four (4) fire extinguishers located by the kitchen area, the front entrance, the rear of the facility hallway, and inside the garage. Extinguishers indicate full charge and display service date: 02/20/2025. Medications are stored in a secured medication cart in kitchen area and are inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete and stored inside living room cabinet. Laundry is located in the hallway, secured by an electric rolling shutter activated by a key switch accessible by staff only. Laundry soaps and other cleaning agents are stored and inaccessible to residents. Hallway area storage cabinets were observed to contain fresh towels, linens and blankets, sufficient for residents. Commons: LPA observed living room, dining area, and all other common areas finding them as clean, organized and clear of obstruction. Furnishings observed as in good condition and provide adequate seating for residents. Multiple large television monitors were observed in common areas and resident bedrooms. Activities were observed as stored in a cupboard section of the living room, along with arts and crafts, board games, puzzles etc. Bedrooms are observed as clean with sufficient lighting, properly furnished with sufficient closet space, bedding, linens, at least one chair, and night stand. [LIC 9099C]-Continued 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 108.0°F. Within the required range. Garage is detached from the house and observed as locked and inaccessible to residents. Garage is also used as storage for emergency food supplies, resident related equipment, bottled water and PPE supplies. Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for residents. Outdoor furniture observed to be in good condition. There are no bodies of water in the facility. All trash cans were observed to be covered. Resident records: LPA observed records stored in a locked and secured office area, 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. Staff records: LPA observed records stored in a locked and secured office area, 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.