Routine inspection (multi-day)·October 16, 2025

At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1-Year Required Visit and met with Facility Staff. Licensee/Administrators, Erik Flatt, Adam Waskow, and Administrator, Matthew Riformo arrived at approximately 9:20AM. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance for 6 non-ambulatory residents and 2 bedridden residents for a total capacity of 6 residents. Facility has an approved hospice waiver for 3 individuals. Upon arrival, LPA was informed that there were 6 Residents in care and 2 staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA conducted a walk-though of the facility with Administrator. LPA observed the following: The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility had emergency lighting. Facility is a 1 story building with 6 Resident bedrooms, 3 bathrooms, and common spaces. Facility has an office space located in the backyard. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Toxins were observed to be stored inaccessible to Residents. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected August 2025. Smoke detectors and carbon monoxide detectors were tested and operational. During walk through, LPA observed prepoured medications for afternoon and evening medication (technical violation issued, regulation 87465(h)(5)). LPA reviewed staff files, resident files and resident medication. All files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. During medication review, LPA observed that one of Resident 1's (R1's) medication was administered without a physician's order (deficiency cited, regulation 87465(e)). Continued on LIC809C Continued from LIC809 LPA requested the following documents to update facility file: Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610E) Updated Personnel Report (LIC 500) Updated Liability Insurance Active and Current Administrator Certificate Documents to be submitted to Community Care Licensing (CCL) by due date of 11/16/2025. No Deficiencies Cited during Visit. Exit interview conducted. Copy of report, LIC809D (deficiency page), LIC9102 (Technical Advisories/Violations), plan of corrections, and appeal rights discussed and provided to Licensee. Signature on form confirms receipt of documents.