Routine inspection·January 5, 2026

On 01/05/2026 at 9:30 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Required Annual Inspection at this facility. LPA was greeted by caregiver who granted access. LPA explained the reason for the visit. Caregiver sent the administrator, Sunday Olowosagba a message and informed him LPA was at the facility to conduct an annual visit. A physical plant tour was initiated at approximately 10:00 a.m., and the following was observed: Entrance: LPA observed required postings at the facility's entrance and a sign in sheet for visitors. LPA observed a fully charged fire extinguisher with service date 05/29/2025. Common Areas: These include the two (2) dining areas, living area and a sitting/office area. All common areas were observed clean. There is a television and board games available to residents in the living room. Facility files are kept locked in filing cabinets in the dining area. Kitchen: LPA observed the kitchen to be clean and clear of clutter. LPA observed a fire extinguisher with a service date of 05/29/2025, fully charged. LPA observed, centralized medications locked in a kitchen cabinet. LPA observed a small refrigerator for medication that requires refrigeration locked. LPA observed a 2 day perishable and 7 day non perishable supply of food in the facility. Surrounding Grounds : There is appropriate outdoor seating for residents. Auditory alarms on exit doors were observed on and functioning. Laundry Room/Garage: LPA observed a washer, dryer detergents and cleaning products locked in the laundry room. Through the laundry room is the door to the garage. Garage is used for facility storage. LPA observed a second refrigerator. (Continued to LIC809-C) (Continued from LIC809) Bedrooms: The facility has three (3) bedrooms that may be shared for a total capacity of six (6) residents. Bedrooms are cleared for one (1) bedridden resident each. All resident rooms are furnished with required lighting, dresser, chair, bed, linens, and storage space. Bathrooms : There are two (2) bathrooms designated for resident use. One (1) bathroom is located in a shared bedroom for private use. All bathrooms were clean, had grab bars, with non skid flooring. LPA observed a sufficient supply of hand soup, toilet paper, and paper towels. Hot water temperature has been measured at approximately, 119 degrees Fahrenheit. Resident file: At approximately 10:52 a.m. to 12:30 p.m., LPA conducted a file review of five (5) out of five (5) resident records. LPA reviewed resident record to insure compliance of licensing forms. LPA's review of Resident #2's (R2's) records revealed from 09/02/25 to 12/24/25 the facility had documented ongoing behavioral concerns and medical concerns. On one occasion on 08/18/25 R2 left the facility without assistance. LPAs review of Community Care Licensing (CCL) records revealed no unusual incident/injury reports regarding R2 have been submitted by the facility. LPA's review of Resident #3's (R3's) records revealed no TB results on file. Staff Files / Facility records: At approximately 12:30 p.m. LPA also conducted a file review of two (2) staff records to insure forms and training are up to date and in compliance with licensing forms. At 12:45 p.m., LPA met with the administrator. LPA reviewed infection control plan, liability insurance and emergency disaster plan (LIC610E). LPA observed smoke detectors through out the facility, they are interconnected and hard wired. LPA observed a functioning carbon monoxide detector on a wall by the bedrooms. At approximately 12:47 p.m. the administrator tested the smoke alarms and they were observed operational. LPA observed fire doors close automatically. Deficiencies were observed during todays visit (refer to LIC809-D). Exit interview conducted. Appeal Rights provided. A copy of this report provided.