Routine inspection·June 4, 2025

On 06/04/2025 at 8:40 am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today's visit was to conduct the one-year inspection. LPA met with Sara Binmoeller (Administrator) and the purpose of the visit was discussed. Facility is licensed to serve residents ages 60 and over. The facility is approved for five (5) non-ambulatory on the first floor, and one (1) ambulatory on the second floor with a hospice waiver approved for five (5) residents and a dementia wavier on file. Currently five (5) residents live at the facility. Four (4) of the residents are diagnosed with dementia, zero (0) residents receive home health, hospice and palliative care. The facility does not handle any of the residents’ money. The facility has a current administrator certificate (#7000216740) for Sara Binmoller application received on 05/22/2025 The facility fees were paid on 05/13/2025 - confirmation code: 968378. The facility has commercial general liability insurance (policy # PCI38510177-04) with Primary Care Insurance, a Risk Retention Group, Inc. (NAIC 16959) with an effective date as 06/04/2025 - 06/04/2026 with each occurrence $1,000,000 and general aggregate $3,000,000. The home is a single home consisting of: (3) resident bedrooms downstairs, (2) bedrooms-upstairs (3) bathrooms (1 upstairs & 2 downstairs), living room, kitchen, two (2) dining rooms, a garage which houses can goods, emergency food and water with three (3) additional refrigerators and 1 freezer, and an outdoor shaded patio area with a backyard. Report continues on LIC 809-C. Between the hours 9:00am - 9:41am, LPA toured the facility resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. oilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. The water temperature tested between 105F - 120F (in bathroom 113.4F). Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards doorways were free of obstructions. Between the hours of 9:45 - 1:15 pm, LPA conducted a records review of (5) residents records, (5) staff records and (5) Client Medication Administration Records and the facility disaster plan. The administrator All client & staff records were complete. The facility disaster plan was current (last conducted on 03/21/2025) and in compliance with Title 22 at the time of visit. LPA did not observed any discrepancies at the time of visit. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous Items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During today’s visit LPA did not observe deficiencies. An exit interview was conducted with Sara Binmoeller, (Administrator) and a copy of this report was provided.