Routine inspection·October 16, 2025

At approximately 9:15 a.m. on 10/16/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an annual inspection. LPA met with staff and disclosed the reason for the visit. The facility is a single story building with six (06) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be nonambulatory and one (01) bedridden in Bedroom #5. The facility serves residents with dementia. LPA observed a maintained front yard with gardened areas. The walkway leading to the main entrance was free of debris. Postings located at the front and side living room included the administrator’s certificate, personal rights, rights of resident councils, facility sketch with evacuation routes clearly labeled, confidential complaint poster, Ombudsman contact poster, house rules, facility license, emergency disaster plan, and emergency contacts. Walls, floors, windows, screens, and blinds were clean and in good repair. At 9:25 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. The hallway contained night lights and a closet for hygiene supplies. A fully charged fire extinguisher was observed near the kitchen. It was last inspected on 09/10/25. The front living room contained exercise equipment, puzzles, board games, a television, and furniture in good repair. The side living room contained emergency water, confidential files, locked medications, and exercise equipment. A washing machine and dryer were located in the garage. Both were in working order. Detergents were locked in a storage shed. The garage stored additional supplies. The facility has two (02) bathrooms. The bathroom designated for residents contained liquid soap, paper towels, grab bars and a non-skid mat in the shower, and a commode with grab bars. It needed some minor repairs to the shower head which was leaking. At approximately 9:45 a.m. LPA measured the water temperature in the resident bathroom to be 108.5 degrees Fahrenheit. The facility has six (06) bedrooms. One (01) bedroom is designated as a staff room. The staff room was unlocked and free of hazards. Four (04) out of five (05) resident bedrooms contained a chair, lamp, nightstand, dresser, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Bedroom #1 did not have a chair or lamp and contained a resident, Resident #1 (R1), who was bedridden. Review of the facility sketch and fire clearance at 10:30 a.m. today revealed Bedroom #5 was the only bedroom designated for a bedridden resident. Review of R1’s medical assessment at 10:35 a.m. revealed they were bedridden. A deficiency is cited for this violation on the corresponding LIC 809-D page. LPA observed an adequate supply of perishable and non-perishable foods stored in the refrigerator, freezer, and pantry. The stove and surfaces were clean. Appliances were in good condition. Sharps were locked below the countertop. Cleaning solutions were locked below the sink. LPA observed a covered patio area in the rear of the facility. The patio contained shaded furniture in good condition. A locked storage shed contained additional supplies. The emergency exit path was free of debris. The exit gate was unlocked. Three (03) out of three (03) auditory alarms were turned on and functioning. LPA reviewed personnel and resident files at 10:00 a.m. All files were available for audit. At approximately 10:35 a.m. LPA observed that Resident #1 (R1) and Resident #2 (R2) did not have tuberculosis tests or chest exams. This deficiency is cited on the corresponding LIC 809-D page. At 11:05 a.m. the house phone was called and confirmed to be functional. At approximately 11:10 a.m., smoke and carbon monoxide detectors were tested and operational. Exit interview conducted. Appeal rights discussed. Copy of report provided.