Routine inspection·April 30, 2026

On Thursday, 4/30/26, 9:45 am , Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct an unannounced inspection visit. LPA met with Administrator, and reason for the visit was discussed. Facility is licensed as a single-story residence, for five non-Ambulatory. Hospice waiver for five (5) residents. Facility has three (3) resident bedrooms and two (2) bathrooms. At 10:15 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. Thermostat displays setting of 70.0°F . within the required range. Facility postings are prominently displayed and observed as current. Disaster drills last conducted on 03/01/2026 . KITCHEN area is clean and uncluttered. At 10:30 am, 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. Two day supply of perishable food is properly stored and labeled. Seven day supply of nonperishable food is available in detached garage and properly stored. Dish Soap, cleaning solutions, and toxins are stored in locked lower cabinet, underneath the kitchen sink. [LIC809C]-Continued FIRE DETECTION SYSTEM: Multiple combination smoke\ carbon monoxide alarm detectors are installed, hardwired and interconnected. Combination Smoke and Carbon monoxide detectors were tested and function properly. Fire extinguisher, located on wall near the dining room and hallway area, indicates as fully charged ; purchase date: 02/25/2026. BEDROOMS : Bedroom#1 is a private resident room; Bedroom#2, and bedroom#3 are shared. All Bedrooms are observed as clean with sufficient lighting, properly furnished with bed, linens, chair, chest of drawers, and night stand. BATHROOMS: At 10:50 am, LPA observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 115°F. Within the required range. Wash cloths and towels are not shared. LAUNDRY: Washer and Dryer machines, soaps, and cleaning agents, are stored in a large outdoor shed observed as locked and inaccessible to residents. Linen storage observed to have adequate supply of linen and towels. GARAGE is detached from the house and observed to be locked and inaccessible to residents. Garage is storage for water, additional linens, towels, and PPE supplies. Garage is also equipped with an additional refrigerator containing perishable foods properly stored and labeled. OUTDOORS: (backyard) area observed with a shaded patio and tables, with sufficient seating for residents; furniture observed to be in good condition. A room behind the facility is an office space. Office contains an additional refrigerator storing perishable foods properly stored and labeled. Office observed to be locked and inaccessible to residents. Outdoor area has a rock fountain enclosed in a 3-ft. gate; observed as dry and not in use. There are no bodies of water in the facility. All trash cans observed to be covered. COMMON AREAS: Dining room is furnished with large table, and seating to accommodate residents and guests. Television, stored games, and reading materials are present. Furniture and fixtures are clean and in good condition. Facility telephone was operational at time of visit. [LIC809C]-Continued RESIDENT RECORDS are stored in secure and locked file cabinet in the office area which is 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. Resident records appear to be complete and current. STAFF RECORDS are stored in secure and locked file cabinet in the office area which is inaccessible to residents. At: 1:25 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 copy of this report was provided to Administrator.