Routine inspection·November 1, 2025

On November 1, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Krystal Adams and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory of which one (1) may be bedridden elderly residents ages 60 and above. The facility is approved for (2) hospice residents. Currently, the facility has (1) resident in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: three (3) resident's rooms, two (2) common bathrooms, one (1) staff bathroom, living area, dining area, kitchen, outside covered patio area, and a laundry room. A garage is being used for storage and office space. LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 110.2 degree F. A comfortable temperature of 74 degree was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report Continues LIC 809-C Fire extinguisher was charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was complete and accurate. A landline telephone was in working condition. The facility has conducted Fire Drills 10/31/25. LPA observed First Aid Kit was maintained. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. The facility has as 30-day Personal Protective Equipment (PPE). An audit of residents #1-#5 (R1-R5) service files and staff #1-#4 (S1-S4) personnel files revealed to be complete. A review of staff CPR/First Aid training is current. The facility has the current administrator's certification on file for Kyrstal Adams #7011810740 valid 05/11/2024 through 05/10/202 6 and for Ronic Tatum #701182470 valid 05/11/24 through 05/10/26. The facility is current on Community Care Licensing annual dues. No deficiencies issued. An exit interview was conducted with Krystal Adams , and a copy of the report and appeal rights provided.