Routine inspection·October 1, 2025

On 10/1/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Caregiver Shela Ferencz, who granted access to the facility. LPA explained the reason for the visit. Facility Administrator Kesha Richardson arrived shortly after. LPA Khurshudyan reviewed the required postings on the hallway next to the entrance area and requested staff and residents’ rosters for review. The inspection tool was used to complete the visit. At 12:00pm LPA, with the help of the Caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with seven (7) bedrooms, of which six (6) bedrooms are designated for residents’ private use, and one (1) office/staff room. There are three (3) bathrooms, a kitchen, common areas: living and dining rooms, and an outdoor area. Facility has an approved fire clearance for six (6) Non-ambulatory residents, of which one (1) can be bedridden in rooms #2,3,4, and a Hospice waiver approval for six (6) residents. Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked kitchen cabinet. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed two (2) fire extinguishers throughout the facility. The fire extinguishers were last serviced on 9/19/2024, LPA was informed that new service date is already scheduled for the following week. A weekly menu was also available for residents. The second refrigerator was also available in the garage for additional food supply. Dish soap and other chemicals were properly stored and locked inside separate closet located in the hallway. Continue on LIC809-C Bedrooms: There are seven (7) bedrooms in the facility. All bedrooms are for residents’ use. LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. Residents have enough personal hygiene products. Common Areas: These include living and dining areas . LPA observed dining, living areas clean and clear of clutter. Furniture is generally new and in a good repair. Dining and living room furniture sits at the capacity of the facility. Walls, floors, windows, screens, and blinds were clean and in good repair. At 12:15pm, LPA measured the room temperature to be 78 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found throughout the facility. Facility has landline, LPA checked it was operational. There is a television, cabinet for activities, books, and art supplies available for clients’ use. Bathroom: There are three (3) bathrooms in the facility. The bathrooms contained hand soap, paper towels, toilet paper and trash bins with lids. The hot water temperature was measured at approximately 12:25pm to be 119.4 degrees Fahrenheit. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested by staff at 12:35pm and were observed to be operational. Garage: The garage is currently being used for storage. Laundry Room: Functioning washer and dryer are located in a separate laundry room located in the hallway. Laundry detergents and other chemical supplies are locked and inaccessible to clients in care. Backyard: LPA observed sufficient yard space and fenced backyard. Appropriately covered shaded area available for clients to rest. There is outdoor furniture under the shaded area. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. All exit doors were unlocked; no obstructions were observed around the emergency exit area. There is no body of water in the property. Staff/Client File review: Facility records are kept inside the locked commercial cabinets located in the office/staff room. Between 10:35am -11:55am LPA conducted records review of five (5) staff files and six (6) residents’ records. Files were complete and updated. Continue on LIC809C Medications : At approximately 12:35pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. The facility also maintains Medical Administration Records (MAR). LPA observed centrally stored medications locked inside the medication closet and inaccessible to residents in care. Complete First-aid kit is also available and placed in the common area. No potentially dangerous items were found in the facility. The facility operates with three (3) shifts and has two to three (2-3) staff members for each shift. LPA conducted an interview with an Administrator, one (1) caregiver and two (2) out of six (6) residents who were able to communicate. Facility plan/sketch is posted on the wall along with other posting requirements. LPA collected LIC500, LIC9020, and a copy of Certificate of Liability Insurance. Liability Insurance - Exp 12/21/2025 The Administrator's certificate - Exp date is 9/30/2026. No Citations issued during today’s visit. Exit interview conducted. Copy of this report provided.