Routine inspection·September 30, 2025

At 11:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an annual inspection. LPA met with the Administrator and explained the reason for the visit. A tour of the physical plant was initiated at 11:35am and the following was observed: The facility is cleared for six (6) Non-Ambulatory residents and a hospice waiver/granted for four (4). Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. LPA observed there to be sufficient stock of perishable and non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives were observed to be locked in the kitchen drawer. The fire extinguisher was purchased on 12/03/2024. Medications and resident/staff files are kept in locked cabinet, in the kitchen. There is a complete first-aid kit it with all required supplies and with the first aid manual. Bedrooms: The facility has a total of six (6) bedrooms, five (5) of which are designated for residents use, one (1) room is designated for live-in staff. The bedrooms are appropriately furnished with sufficient closet space and have sufficient lighting. All exit doors will have an auditory alarm. Bathrooms: Facility has three (3) bathrooms. Bathrooms have soap, paper towels and all trash cans have a lid. Extra towels and linens were readily available. The hot water temperature measured at 114.1°F. The facility maintains a comfortable temperature of 76°F. LPA observed all common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. There is a functioning telephone on the premises. Continue on LIC809-C Smoke detectors carbon monoxide is located throughout the facility and at 12:00pm they were tested and observed to be operational. Laundry Room: The laundry is located by the office/kitchen area. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Outside Areas: The back of the facility has sufficient yard space. At 12:30pm, LPA observed appropriate outdoor furniture, with a covered shaded area for the residents. The outdoor area is free of visible immediate hazards. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Between 12:40pm to 1:20pm, LPA reviewed records of six (6) residents and three (3) 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 documentation. LPA observed Administrator certificated renewed on 05/08/2024 with an expiration date of 05/07/2026. LPA collected Certificate of Liability Insurance and LIC500. No citations issued during this visit. Exit interview conducted and copy of this report signed and delivered.