Routine inspection·April 30, 2026

On Thursday, 04/30/26, at 9:45 am , Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct an unannounced inspection visit. LPA met with the Administrator, and reason for the visit was discussed. Facility is licensed as a single-story residence. Fire clearance approved for four (4) non-ambulatory and one (1) bedridden resident in bedroom#1. Hospice waiver approved for five (5) residents. Facility has three (3) resident bedrooms; One (1) private bedroom and two (2) shared bedrooms. At 10:10 am, LPA conducted a tour of the physical plant with the Administrator and observed the following: PHYSICAL PLANT: Facility’s main door is the primary entry/exit access. All facility exits signal an auditory alert when accessed. 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 throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 118.0°F. within the required range. Required facility postings are prominently displayed and observed to be current. Disaster drills were last conducted on 4/01/26. FIRE DETECTION SYSTEM: Multiple smoke alarms are installed, hardwired, and interconnected. Smoke and carbon monoxide detectors were tested and function properly. LPA observed one (1) fire extinguisher, located on dining room wall near the hallway. Purchase/Service Date: 2/25/26. [LIC 809C-Continued] KITCHEN: At 10:45 am, LPA observed kitchen as clean, and clear of obstruction; stove, refrigerator, and multiple appliances are working properly. Facility maintains adequate supply of perishable, and non-perishable food. Foods observed as properly labeled and stored. Kitchen cabinets store dishes, plastic, paper goods and utensils. Knives and sharps are secured in a locked drawer and inaccessible to residents. MEDICATIONS: Meds are stored in a secured cabinet, near the kitchen, and inaccessible to residents. Facility has fully stocked first aid kit and manual located in the medication cabinet. BEDROOMS: All Bedrooms are observed as clean, with sufficient lighting, and properly furnished with bed, linens, chair, chest of drawers, and night stand. RESTROOMS: At 11:25 am, LPA observed restroom as clean and sanitary, with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured 115.0 F; within the required range. Washcloths and towels are not shared. LAUNDRY: Washer and dryer machines, soaps, and other cleaning agents, are stored in a large outdoor shed observed as locked and inaccessible to residents. Linen storage observed containing adequate supply of linen and towels. COMMON AREAS: Dining room is furnished with large table and seating to accommodate all residents. Sofa, television, stored games, reading materials are present and available. Furniture and fixtures are clean and in good condition. Facility telephone and internet access was operational at time of visit. OUTDOORS: (backyard) area observed having a shaded patio, table, and sufficient seating for the residents. Furnishings observed to be in good condition. A room behind the facility is an office space. Office contains an additional refrigerator which stores resident foods properly stored and labeled. Office observed to be locked and inaccessible to residents. Rock fountain enclosed in a 3-ft. gate and observed as dry and not in use. There are no bodies of water in the facility. All trash cans were observed as covered. [LIC 809C-Continued] RESIDENT RECORDS: located in the office area are stored in locked cabinets inaccessible to residents. At 12:15 pm, Records were reviewed for current IPP and/or Needs and Services plans, physician report, appraisals, and admission agreements, and other required documentation; resident records appear to be complete and current. STAFF RECORDS: located in the office area are stored in locked cabinets inaccessible to residents. At 1:40 pm, Records were checked for criminal record clearances\associations to this facility and other required documentation. Staff records appear to be complete and current. No immediate health and safety hazards observed during the day of inspection. Exit interview conducted and a copy of this report was given to Administrator.