Routine inspection·July 29, 2025

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 9:35 am. LPA Smith was greeted by staff and disclosed the purpose of the visit. Staff contacted the administrator. LPA Smith spoke with the administrator and disclosed the purpose of the visit. Administrator revealed spouse who is also an administrator will arrive shortly. LPA conducted a tour of the physical plant at approximately 10:20 am to ensure there are no health and safety hazards, and the facility follows Title 22 Regulations. Common areas were observed for the ability to safely serve the needs of residents. These included the kitchen, dining room area and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the five (5) residents currently residing there. Two (2) days of perishable and seven (7) days of nonperishable food observed. The freezer is stocked with frozen foods. The residents’ medications are locked in cabinet in the kitchen and observed to be locked and inaccessible to residents. Sharps are locked in kitchen island drawer observed to be locked and inaccessible to residents. The stocked first aid kit is stored above the medication cabinet in the kitchen. There are five (5) fire extinguishers: One (1) attached to the wall in the kitchen and four (4) in laundry room with one (1) attached to the wall. Fire extinguishers observed to be charged. The laundry room is located at the end of the first hallway by enclosed patio. The appliances observed to be (cont from 809) in good repair. Toxins stored in cabinet in laundry and under kitchen sink. Toxins observed to be locked and inaccessible to residents. The facility has a total of six (6) bedrooms and three (3) bathrooms and half bathroom. There are four (4) private bedrooms with (1) shared for residents and one (1) bedroom for staff. The residents’ bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens hall closet near bathroom. The bathrooms have the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range measured:109.5- 118.7 degrees Fahrenheit. Backyard has the following: Covered enclosed patio with Two (2) Patio tables observed to have adequate seating. Patio furniture was observed to be in good repair. One (1) umbrella with table and one (1) umbrella stored in garage. Garage: Used to store PPEs, 2nd refrigerator food overflow and equipment. Pool gated and locked. Carbon monoxide detector/ Smoke detectors were tested and operable at the time of visit. Facility grounds were free of hazards. There were no immediate health and safety hazards observed during the day of inspection. At approximately 11:55 am, LPA Smith reviewed (6) residents and four (4) staff files. Resident files included but not limited to: Admission agreements, Physicians reports, Preadmission appraisals and consent forms. Staff records reviewed had the appropriate personal records such as: Clearances, Dementia trainings First aid/CPR. Dementia Care Plan name correction to be sent to LPA. No deficiencies cited. Exit Interview Conducted / A Copy of the Report Issued