Routine inspection·August 21, 2025

On 08/21/25, 10:30 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 five (5) non-ambulatory. Hospice waiver for five (5). Facility has three (3) total bedrooms, and two (2) bathrooms. 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 72.0°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: July 2025. 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. A two-day supply of perishable food was observed as properly stored and labeled. A seven-day supply of nonperishable food is stored and available to residents. Dish Soap, cleaning solutions, and toxins are stored in a locked shed near the kitchen. [LIC 809C-continued]--- Fire Detection/Protection system is present in the facility. Multiple dual smoke alarm/ carbon monoxide detectors are installed, hardwired, and interconnected. Detectors were tested and function properly. LPA observed two (2) fire extinguishers located at front and rear exits. Extinguishers display a full charge; Service date: 01/07/2025. Medications are stored in a secured medication cart near the 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 the living room cabinet. Laundry: LPA observed laundry area, located in room adjacent to the kitchen. Laundry soaps, and other cleaning agents, are stored and inaccessible to residents. Hallway area storage cabinets contain fresh towels, linens and blankets, sufficient for residents. Commons: LPA observed living room, and dining area, finding them clean, organized, and clear of obstruction. Furnishings observed to be in good condition and provide adequate seating for residents. Activities were observed stored in living room cabinet, with contains 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. Bathrooms were observed to be clean and sanitary with necessary personal hygiene supplies and required safety fixtures (grab bars, anti-slip floor striping). Hot water temperature measured at 117°F. Within the required range. Towels and washcloths are not shared. Garage is detached from the house and observed to be inaccessible to residents. Garage is also used as storage, extra water and PPE supplies. [LIC 809C-continued]--- Outdoor (backyard) area observed to have a shaded patio, with tables and seating sufficient for residents and visitors. Outdoor furniture was observed to be in good condition. There are no bodies of water in the facility. Resident records are stored in staff office and inaccessible to residents. Records were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. Resident records appeared to be complete and current. Staff records are stored in staff office and inaccessible to residents. Staff files contain criminal record clearances and are associated to this facility. Staff records appear to be complete and current. There were no health and safety hazards observed during the day of inspection. Exit interview conducted and a copy of this report was given.