Routine inspection·May 15, 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 the 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. Facility also has a hospice waiver for one (1) resident. 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 6/24/2024. Medications and resident/staff files are kept in a kitchen cabinet and observed to be locked and inaccessible to residents in care. The first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Facility is a single-story home consisting of seven (7) bedrooms and three (3) full bathrooms. There are six (6) private bedrooms designated for residents use. Only master bedroom has a private bathroom. Live-in staff bedroom is located by the kitchen area. LPA observed that all bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. At 12:20pm LPA observed all bathrooms are clean and in good repair. All three (3) bathrooms have a working Continue on LIC809-C toilet, wash basin, and a shower/bathtub. Properly supplied with toilet papers, soap and paper towels. At 12:30pm, the hot water temperature measured at 116.7°F. All trash cans in bathrooms had fitted lids to protect from cross contamination. Laundry is located in the garage. The washer/dryer appear to be in good condition. Laundry supplies, chemicals and detergents are kept in the garage and inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested at 12:40pm and observed to be functional. At 12:50pm, LPA observed sufficient yard space with fenced backyard. The outdoor area was free of visible immediate hazards. There is a swimming pool that is fenced to keep clients out of the swimming pool area. The fence is approximately 5 feet high throughout the parameters. You will need a key to unlock the padlock to gain entry to the swimming pool as it is kept locked at all times. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Between 1:00pm to 2:30pm, LPA reviewed records of six (6) residents and three (3) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentarians. LPA collected Certificate of Liability Insurance, Administrator Certificate (exp. 11/04/2025) and LIC500. No citations issued during this visit. Exit interview conducted and copy of this report signed and delivered.