Routine inspection·October 29, 2025

At 12:00pm, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with Staff #1 who granted access to the facility. Administrator arrived shortly after, and LPA explained the reason for the visit. At 12:05pm LPA conducted a tour of the physical plant and observed the following: Facility is licensed for capacity of six (6) Non-Ambulatory residents. Hospice approval for six (6) residents is also available. Facility maintains a temperature of 75°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. All knives were observed to be locked in the kitchen drawer. The fire extinguisher is located in the kitchen area and was last serviced on 09/24/2025. At 12:15pm, LPA observed all medications stored in the kitchen cabinet and kept locked and inaccessible to residents in care. Laundry is located by the kitchen. The washer/dryer appeared to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. There are six (6) bedrooms designated for resident's’ use. Bedrooms are appropriately furnished and have appropriate lighting. Facility has live-in staff and the staff room is located at the den area. Bathrooms have soap and paper towels. Slip-resistant mats are used in all bathtubs and shower floors. All toilets, handwashing and showers are observed to be in good operating condition. All containers storing waste are emptied in a timely manner and observed to be in good repair and free of leaks. Extra towels and linens were readily available. The hot water temperature measured at 117.2°F. Continue on LIC809-C Smoke detectors and carbon monoxide monitors were tested at 12:20pm and observed to be functional. At 12:25pm, LPA observed appropriate outdoor furniture with a covered shaded area for residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Smoke detectors were located throughout the facility, and the carbon monoxide was located by the dining area and at 12:30pm they were tested and observed to be operational. Between 12:30pm to 1:30pm, LPA reviewed records of five (5) residents and three (3) staff. Resident and staff records appeared to be complete and updated. LPA observed Administrator certificated renewed on 04/06/2024 with an expiration date of 04/03/2026. LPA collected Certificate of Liability Insurance and LIC500. No citations were issued during this visit. Exit interview conducted and copy of this report signed and delivered.