Routine inspection·July 28, 2025

On 07/28/2025 at 11:15 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 Elsa Roman, Administrator and the purpose of the visit was discussed. The The facility is licensed to serve 6 non-ambulatory only residents and a waiver granted for an approved hospice care for five (5) residents. Five (5) of the residents are diagnosed with dementia, zero (0) residents receive home health, and one (1) of the residents are receiving hospice care services. The facility does not handle any of the residents’ money. The facility has a current administrator certificate (#7012218740) for Elsa Roman valid from 06/24/2024 - 06/23/2026. The facility fees are current. The facility has liability insurance with James River Casualty Company (NAIC# 13685) with each occurrence at $1,000,000 and general aggregate at $3,000,000 (policy #00150009-1) effective date 11/17/2024 - 11/17/2025. The facility fees are current. The home is a single home consisting of : (5) resident bedrooms, (2) full bathrooms, living room, a kitchen, a washer and dryer area, a dining area, a living room, a backyard with two (2) shed with additional storage and an outdoor shaded patio are in the backyard. Report continues on LIC 809-C Between the hours 11:29 am - 11:52 am, LPA toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets 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 measured at 112.5°F (in the kitchen), 112.5 °F (in bathroom #1) and 110.7°F (bathroom #2). 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 11:52 am - 2:30 pm, LPA conducted a records review of (5) residents records, (5) staff records and (5) Client Medication Administration Records and the facility disaster plan. All client & staff records were complete. The facility disaster plan was current (last conducted on 07.08.2025) 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 any deficiencies. An exit interview was conducted with Elsa Roman (Administrator) and a copy of this report was provided.