Routine inspection·September 26, 2025

On 09/26/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Staff. Administrator Matthew Palmer and Area Manager Irene Formentera arrived later. Facility is licensed to serve six (6) non-ambulatory of which two (2) may be bedridden. The facility also has an approved hospice waiver for six (6) residents. There are currently two (2) residents receiving hospice care services. The annual fees are current. The home consists of one (1) floor level which includes: one (1) staff room, four (4) resident rooms, two (2) bathrooms, kitchen, laundry area, dining room, living room, backyard patio area with furniture, and a detached garage. The facility is clean, sanitary, and in good repair. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens, and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Common bathrooms were checked. Continue to LIC809-C. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, a non-skid mat was in place, and hot water temperature properly measured at 112.5 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean, clear of hazards, and doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. Two fire extinguishers last serviced August 22, 2025 were observed near the laundry area and in the dining area. Fire prevention inspection was conducted on 02/29/2024. Five (5) staff records were reviewed, five (5) out of five (5) had current first aid certificates and required criminal record clearances or criminal record exemptions. Three (3) resident records were reviewed and, three (3) out of three (3) resident records had medical assessments and pre-appraisal or reappraisals. Two residents’ medication was reviewed. No deficiencies are being cited. An exit interview was conducted, and a copy of this report was discussed and left with the Area Manager Irene Formentera.