Routine inspection·February 4, 2026

On 2/04/2026 at approximately 4:10 p.m., Licensing Program Analyst (LPA), Evelin Rios conducted an annual visit to the facility. LPA met with the Administrator and explained the reason for the visit. The facility has not accepted any residents. LPA conducted a physical plant tour at approximately 4:10 p.m., and the following was observed: The facility is a single unit building with (4) bedrooms and two (2) bathrooms. There is no designated staff room. A fire clearance was approved on 06/26/2024, for six (6) non-ambulatory residents for a total capacity of six (6). Common areas: The living room and dining room were observed to be properly furnished and in good repair. LPA observed a fire extinguisher in the kitchen and living room to be fully charged with service date 02/07/2025. LPA observed required postings located throughout the common areas. A working telephone was observed accessible to residents. Kitchen: The kitchen was observed clean and clear of clutter. LPA observed a sufficient supply of seven (7) day nonperishable foods and two (2) day perishable foods. The knives/sharps are kept locked in a kitchen drawer. Bedrooms: The residents' bedrooms are adequately furnished with appropriate furniture and storage space. The passageways and hallways were observed free of obstructions. LPA observed extra linens in a hallway cabinet leading towards the bedrooms. (continued on LIC 809-C) Smoke detectors and carbon monoxide: LPA observed the smoke detectors and carbon monoxide to be working properly and were tested by the administrator at 4:35 p.m. Bathrooms: The bathrooms were clean and supplied with hand soap, paper towels and toilet paper. The bathroom was observed with grab bars and non slip mats in the showers. The hot water delivered in the bathroom was measured at 4:55 p.m. and read between 118 and 119 degrees. Laundry Room: The laundry room is accessible to residents. Detergents and cleaning supplies are locked in the cabinet. Medications will be kept in a locked cabinet in the laundry room. Garage: The garage can be accessed from inside of the facility. LPA observed the garage is accessible from the laundry room. In the garage LPA observed the facility's emergency food. Backyard: The backyard of the facility has a patio that offers a shaded area for residents. LPA observed appropriate outdoor furniture. There is no body of water. Administrator has an active administrator certificate and first aid CPR is up to date. License fee is paid. No deficiencies observed. Exit interview was conducted and a copy of this report was provided.