Routine inspection·August 8, 2025

Licensing Program Analyst (LPA) Sakinah Madyun conducted an unannounced Required Annual Visit. LPA met with Licensee Deborah Davis, Administrator Daniel Davis, and explained the purpose of the visit. The Residential Care Facility for the Elderly is licensed to serve six (6) Non-Ambulatory residents ages 60 and above. Facility has an approved Hospice Waiver to retain/accept six (6) residents of which two (2) may be Bedridden. Currently, there are three (3) residents in placement, one (1) Hospice, zero (0) Bedridden (0) Exceptions, and one (1) receiving Home Health Care. LPA observed (3) residents at the time of this visit. LPA Madyun requested copies of Personnel Report (LIC 500), and Resident Roster (LIC 9020) were provided. Physical Plant/Environment Safety: A tour of the single-story facility began at approximately 10:35 am that included rooms: one (1) private staff bedroom with an exiting door, one (1) staff/visitors bathroom, one (1) staff lounge (located in garaged area), five (5) bedrooms with an exiting door, one (1) resident bathroom, a living room, a dining area, a family room, and a kitchen. All resident bedrooms have the required furniture for privacy, comfort, and safety. LPA observed the carbon monoxide detectors, fire sprinklers, and inter-connected smoke detectors throughout the hallways and rooms. LPA observed required auditory devices on exits of each room. Three (3) Fire extinguishers were fully charged and located in the kitchen, garage, and directly outside the staff office and last inspected on 6/7/25. First-aid kit was fully stocked with a first-aid manual locked securely in the staff office. LPA did observe the Emergency Disaster Plan last reviewed and updated May 2025. Front Yard: Was clean and well maintained without any hazards. Continued LIC 809C Kitchen: LPA observed a sufficient number of perishables for two (2) days, and a seven (7) day supply of non-perishables. LPA observed knives and sharps locked away secured in the kitchen cabinet to be inaccessible to three (3) out of six (6) residents in care. LPA Madyun observed several bottles of cleaning solutions and disinfectants located in the bottom kitchen cabinet to be locked away secure and inaccessible to three (3) out of six (6) residents in care. Water temperature measured at 113.7 degrees F, which is within the required 105-120 degrees F under Title 22 regulations. Kitchen appliances were observed to be clean and in working order. Family room/Living room/Dining Area: Family room was observed with ample seating and lighting. Dining Area was observed to be clean and contained one table with ample seating. The living room was observed with ample seating and lighting. Linen Closet: Contained sufficient linens, towels, and hygiene products. Bathrooms: Bathrooms are clean and operational with grab bars, and skid resistance floors. Water temperatures measured at 113.5-114.8 degrees F, which is within the required 105-120 degrees F under Title 22 regulations. Both bathrooms were observed to be clean and in good condition. Centrally Stored Medications: LPA observed the medication for all residents being locked and securely stored in the staff office. Backyard: LPA observed multiple shaded seating areas. No large bodies of water were observed. Emergency Drills: LPA observed the smoke alarms tested and a Fire Drill log documenting the last fire drill conducted 7/10/25. Staff Personnel Files: LPA reviewed files for (3) staff. Resident Files: LPA reviewed files for (3) residents and medication logs. Liability Insurance & Infection Control Plan: Licensee has current Liability Insurance. Annual fees are paid in full and current. Infection Control Plan was last reviewed and updated May 2025. Exit interview was conducted with Licensee Deborah Davis and a copy of this report and appeal rights will be provided.