Routine inspection·November 24, 2025

11/24/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. There are currently 7 residents in care. Facility approved/cleared for 10 non-ambulatory and hospice waiver for 2. LPA and Licensee toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. All rooms were furnished per regulation. LPA observed a ring camera in room #4, according to Licensee the residents family brought the camera so they can monitor them . Licensee agrees to submit a plan to CCL that the camera provided by the family has no audio, is only accessible to the family, and is not pointing towards the door so the camera does not capture other residents walking by if the door were to be open. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 112.1 and 116.2 degrees F, which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected November, 2025. Smoke/Carbon Monoxide detectors located throughout the facility were tested and operational. Sharps are kept in a locked box located above to refrigerator. Toxins and chemicals are located in the laundry room and were found to be secured. Medications were found to be centrally stored. LPA conducted spot medication count and found all prescription medication to be properly recorded on the Centrally Stored Medication Record. LPA conducted a review of four resident records. All records had the required documentation, however LPA observed two out of four residents needing an updated medical assessment. Facility has documentation showing they have been reaching out to residents physicians for an updated medical assessment. continued on LIC809-C Resident (R1) physicians report from May of 2024 shows a diagnosis of dementia and bedridden ambulatory status, documentation shows licensee followed up with physician on 10/29/2025 to get an updated physicians report that shows an accurate ambulatory status as facility doesn't believe R1 is bedridden . LPA observed R1 to be ambulating with a walker. Licensee will keep following up with physician to get an accurate ambulatory status and updated physicians report. LPA conducted review of three staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training as well as current 1st Aid & CPR certification on file. No deficiencies cited during today's inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 12/24/2025 of this visit: LIC500- Personnel Report LIC308- Designation of Responsibility Updated Liability Insurance Exit interview conducted with Licensee and a copy of this report was provided.