Routine inspection·July 21, 2025

On 07/21/25, 10:15 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced Annual visit to this facility. LPA met with Administrator, and reason for the visit was disclosed. Facility is licensed as a one-story residence, with kitchen area at sub-floor level, fire clearance for eleven (11) non-ambulatory, of which, eleven (11) may be bedridden. Hospice waiver for eleven (11). No residents are receiving hospice services at this time. Facility has nine (9) resident bedrooms, and ten (10) bathrooms. At 10:35 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. Screening area is located upon entrance. Alarm sensors are present at all exits and require a code to deactivate. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, and other necessary signage are posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 75.0°F. within the required range. An approved Mitigation and Infection Control plan is on file. Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 4/01/2025. Fire Detection/Protection system is present in the facility. Multiple dual-carbon monoxide detector/smoke alarms are installed, hardwired, and interconnected. Fire alarms were tested and function properly. LPA observed One (1) fire extinguisher located in the kitchen area, and one extinguisher located in the main hallway. Both extinguishers show service date: 01/07/2025. [LIC 809C Continued] Kitchen: LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, with adequate supply of perishables and non-perishable food. Pantry space stores emergency dry food, condiments, and can goods. Food 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 are stored in a secured medications cart in dining room area and are inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. A First Aid kit is complete and stored in the medication cabinet. Laundry area is located in secured room adjacent the main kitchen. Laundry soaps and other cleaning agents are stored and inaccessible to residents. Storage observed to have adequate supply of linen and towels. Commons: LPA observed all common areas of the facility, including the living room and dining areas, to be clean and organized. Furnishings are in good condition. Bedrooms are observed as clean with sufficient lighting, properly furnished with bedding, dressers, closets, linens, at least one chair, and night stand. Bathrooms were observed to be clean and sanitary, with necessary supplies and required safety features. (grab bars, anti-slip floor stripping) Hot water temperature measured at 112°F. , within the required range. Outdoor area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans observed as covered. No bodies of water in the facility. Resident records: At 12:35 pm, Resident files were reviewed for current IPP, Needs and Services plans, physician report, and admission agreements. Resident records appear as complete and current. Staff records: Staff files were reviewed. Criminal record clearances, and health screenings were present. Staff are associated to this facility. Staff records appear as complete and current. There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to facility's Administrator.