Routine inspection·September 5, 2025

On 09/05/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Administrator, Robert Smith, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) residents aged 60 and up, five (5) of which may be non-ambulatory and one (1) bedridden, with an approved hospice waiver for four (4) residents. Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. The facility consists of three (3) resident bedrooms, 2 bathrooms, living room, dining room, office area, kitchen, and attached garage. In the back is a patio with table and chairs available for resident use. LPA did not observe any bodies of water on the premises. There are no security bars on the windows. Bedrooms LPA inspected the three (3) resident bedrooms and observed them to be clean and in good repair. LPA observed resident rooms have the required furniture, including beds, dresser, nightstand, chair, and storage space for resident’s personal belongings. LPA observed the resident beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens in good repair. Bathroom LPA inspected the bathrooms and observed them to meet Title 22 regulations. LPA observed the bathrooms are clean and operational. LPA observed there are secured safety handrails in the showers. LPA observed an ample supply of towels and hand towels. LPA observed an ample supply of hygiene supplies. The water temperature measured 110.5-degrees and 111.8-degrees Fahrenheit. LPA observed cleaning supplies secured in a locked cabinet Kitchen LPA observed the kitchen was clean and sanitary. LPA observed an ample supply of dishware, cookware, and cutlery. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. LPA observed knives and sharps secured in a locked cabinet. The water temperature measured 110.6-degrees Fahrenheit. Common Areas LPA observed the living room has a couch and recliner to accommodate residents. LPA observed a fireplace screened and inaccessible to residents. LPA observed the dining room has a large table and chairs to accommodate residents. LPA observed games and activities available for residents’ use. Medications LPA observed Centrally Stored Medications secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA observed medications in their original packaging. LPA reviewed the medications and Medication Administration Record (MAR) for four (4) residents and observed four (4) out of four (4) resident medications are consistent with properly documented records. Safety LPA observed smoke and carbon monoxide detectors are operable and in compliance. LPA observed a fully charged fire extinguisher, last serviced on 12/09/2024, mounted in the kitchen. The last emergency drill was conducted on 06/18/2025. LPA observed the First Aid kit is fully stocked and has the required items. LPA observed the required documents are posted throughout the facility. The facility has a working landline telephone. LPA observed cleaning supplies secured in a locked cabinet. No firearms or ammunition are stored at the facility. File Review LPA reviewed the files for four (4) residents. LPA observed four (4) out of four (4) resident files contained the required documents. LPA reviewed the file for the administrator and one (1) staff. LPA observed staff have the required documents, training, and certification. The administrators Administrator Certificate is valid till 04/13/2026. LPA observed Licensing Fees are current. Infection Control LPA observed the facility’s infection control practices. Upon entry LPA observed a Sign-In Log at the entrance and hand sanitizer. LPA observed Infection Control signs posted throughout the facility. LPA observed a 30-day supply of PPEs. LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Robert Smith, and a copy of this report was provided.