Routine inspection·July 28, 2025

On 7/28/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Administrator Illenberger Jeffrey Michael, who granted access to the facility. LPA introduced herself by showing her department badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall throughout the facility. The inspection tool was used to complete today's visit. At 1:15pm LPA began a physical plant tour of the facility and the following was observed: This is a single-story building with four (4) bedrooms, two (2) bathrooms, kitchen, garage, common areas, and outdoor areas. This facility is a Residential Care Facility for the Elderly (RCFE). A fire clearance was approved for six (6) Non-Ambulatory residents and one (1) Bedridden resident. The facility also has a Hospice waiver for two (2) residents. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected; they were tested and are operational. The facility has three (3) fire extinguishers that were last purchased on 9/28/24: the first one is located by the entrance, on the wall, the second one is located in the kitchen area, and third one is on the hallway by bedroom #4. 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. An emergency supply of food / water was stored inside the kitchen cabinets and pantry. Food storage and preparation areas are clean and inaccessible to pests. A weekly menu was also available for clients. Continue on LIC809-C Bedrooms: There are four (4) bedrooms in the facility, and all are designated 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. 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 1:20pm, LPA measured the room temperature to be 74 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 residents’ use. Emergency alarm signals were present on all exit doors. Bathroom: There are two (2) 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 1:25pm to be 107.6 degrees Fahrenheit. LPA also observed required signs on the bathroom walls and non-skid mats inside the showers. Garage: LPA observed the garage is attached to the facility and is currently being used as storage for PPE supplies and for emergency water. Laundry Room: Functioning washer and dryer located in a separate locked area, adjacent to bedroom #4. The laundry detergents and other chemical supplies are also located in the same area, inside the locked closet and inaccessible to residents in care. Backyard: LPA observed sufficient yard space and fenced backyard. Appropriately covered shaded area available for residents to rest. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. Exit doors were unlocked and free of obstructions. There is no body of water in the property. Continue on LIC809-C Staff/Client File review: Facility records are kept inside the locked staff room, located by the dining / living area. Between 2:00pm- 2:45pm LPA conducted records review of three (3) staff files and one (1) resident records. Files were complete and updated. Medications : At approximately 2:45pm. 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 cabinet located in the hallway close to bedroom 4, and inaccessible to residents in care. Complete First-aid kit is also located inside the same cabinet, new manual for first aid kit was also available. No potentially dangerous items were found in the facility. The facility operates with two (2) shifts and has two (2) staff members for each shift. The resident was present during the visit, LPA conducted an interview with the resident, no concerns were brought up to LPA’s attention. Facility plan/sketch is posted on the entrance wall along with other posting requirements. LPA collected LIC500, LIC9020, and the Liability Insurance Certificate copy The Administrator's certificate - Exp date is 11/25/2025. Liability Insurance - Expires 12/5/2025. No citations issued during today's visit. Exit interview conducted. Copy of this report provided.