Routine inspection·September 9, 2025

On 09/09/2025 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced annual required visit. LPA was greeted by Staff #1 (S1) who granted access. S1 contacted the administrator, Monica Gory to let them know LPA was at the facility. LPA informed the administrator by telephone the purpose of the visit. Administrator met LPA shortly after. LPA reviewed the register of facility residents, and the staff schedule. LPA initiated a physical plant tour at approximately 10:20AM, and the following was observed: Bedrooms: There are four (4) total bedrooms for resident use. Two (2) out of the four (4) bedrooms are designated to be shared. Bedrooms were observed to be properly furnished with appropriate furniture, bedding and sufficient lighting. LPA observed hallway cabinets used as storage for facility supplies such as linens. LPA observed a closet by room #4 that was locked. In the closet LPA observed emergency water, a first aid kit and residents' medication. Bathrooms: There are three (3) bathrooms. One (1) bathroom is located in a shared bedroom for private use. Bathrooms were properly supplied with toilet paper, paper towels, hand soap, and nonskid matts. LPA observed proper fixtures such as grab bars. Hot water temperature was measured at 10:54AM in the bathroom closest to the bedrooms and it read 105 degrees Fahrenheit, within regulation. Common Areas: These include the living room and dining room. The areas were clean and clear of clutter. Passageways were free from obstructions. LPA did not observe any tripping hazards. The dining table and chairs sits the capacity of the facility. (Continue to LIC809-C) Kitchen: At 10:31AM LPA toured the kitchen. S1 was observed cleaning the area. The appliances used such as stove/oven, microwave, and refrigerator appeared functional. LPA found a sufficient amount of two day perishable and seven day non-perishable food at the facility. LPA observed repackaged food properly labeled and in appropriate food storage containers. LPA observed fire extinguisher by the kitchen fully charged with purchase date 10/22/2024. Garage/Laundry: The garage was observed locked. In the garage the facility stores supplies, has an extra refrigerator, deep freezer, washer and dryer. LPA also observed cleaning supplies and chemicals stored in the garage that is maintained locked. The washer and dryer were observed operable. Backyard: The backyard is fenced in. LPA observed outdoor furniture and a patio with shade for residents. The backyard is sufficient in space for outdoor activities. Records: LPA reviewed three (03) of three (03) resident records and three (03) staff records for compliance with licensing forms. LPA also reviewed facility's Emergency Disaster Plan(LIC610E) that was reviewed by administrator on 03/01/2025. The facility last conducted an emergency disaster fire drill on 07/22/2025. LPA reviewed the facility's Liability Insurance which is current. Medication: Medication and Centrally Stored Medication Records were reviewed for accuracy and completeness. LPA Rios observed the administrator test the dual smoke and carbon monoxide detectors at 12:52PM. They were observed operational through out the facility. No deficiencies issued. Exit interview conducted. Report provided.