Routine inspection·July 22, 2025

At 10:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual inspection. Upon arrival, LPA met with Staff #1 who granted access to the facility. The Designee arrived shortly after, and LPA explained the reason for the visit. At 10:10am LPA conducted a tour of the physical plant and observed the following: Facility is licensed for capacity of six (6), of which five (5) may be Non-Ambulatory and one (1) bedridden resident in room #1. The facility also has a hospice waiver for five (5) residents. There are four (4) bedrooms designated for residents’ use. Bedrooms are appropriately furnished and have appropriate lighting. The facility has awake staff. Bathrooms have soap and paper towels. Extra towels and linens were readily available. The hot water temperature measured at 108.5°F. Facility maintains a temperature of 73°F. LPA observed there to be sufficient stock of one-week perishable and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. At approximately, 10:25am LPA observed medications are centrally stored and locked in the kitchen cabinet. The fire extinguisher is located in the kitchen and was last purchased on 04/21/2025. The laundry is located by the garage. The washer/dryer appears to be in good condition. All chemicals and detergents are kept in the laundry room and inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested at 10:30am and observed to be functional. At 10:40am, LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is a swimming that has a fence installed to keep residents out of the area. The fence is approximately 5 feet high throughout the parameters. Continue on LIC809-C You will need a key to unlock the padlock to gain entry to the swimming pool as it is kept locked at all times. Between 11:00am to 12:00pm, LPA reviewed records of five (5) residents and four (4) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentarians. Annual fee is paid in full. LPA observed Administrator certificate renewed on 09/20/2024 with an expiration date of 09/19/2026. LPA collected Certificate of Liability Insurance and LIC500. No citations were issued during this visit. Exit interview conducted and a copy of this report signed and delivered.