Routine inspection·November 20, 2025

At approximately 8:45 AM Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an annual inspection of this licensed senior care facility. LPA met with Licensee/Administrator Kelly Muelrath. The facility is single story, with 3 bedrooms and 2 bathrooms. Facility has a fire clearance for 6 non-ambulatory residents and Hospice waiver for 3. There are currently 6 residents in care, of which 3 have diagnoses of dementia and 2 are receiving hospice. At approximately 8:55 AM LPA toured the building and grounds with Licensee/Administrator which were found to be at a comfortable temperature, clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity space & activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerator and freezers were clean, and food was stored properly. Toxins are stored in locked closet across from laundry room & in locked cabinets under kitchen-sink. Water temperature measured between 107.6 degrees F & 107.9 degrees F, within regulations of 105 degrees F and 120 degrees F at faucets accessible to residents. Bathrooms were equipped with necessary grab bars, and slip-resistant mats and shower chairs in both shower floors as required by Title 22 regulations. Fire extinguishers were last charged 1/8/2025. There are 7 hardwired combination smoke /carbine monoxide detectors last inspected 10/7/2025 along with 2 additional carbon monoxide detectors found to be operational. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure. At approximately 9:45 AM, LPA reviewed 5 resident records and found all residents have current physician's reports & care plans. All resident records contained current and signed admission agreements and contained physician's medication orders for each resident, as well as all required documentation. Continue on LIC809 Continued from LIC809 At approximately 11:35 AM, LPA reviewed 5 staff records. All records contained documentation of completed training as required. Evidence of current first aid and CPR training were present. All staff records reviewed had required criminal record clearance and associated. At approximately 12:20 PM the Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 11/20/2025. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. At approximately 12:50PM, LPA reviewed the facility emergency disaster plan with staff. Facility has a generator to supply power during an emergency outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducts and documents disaster drills quarterly & in different shifts with the last being 10/7/2025. Administrator Certificate’s for Kelly Muelrath # 7031393740 Exp. 9/26/2027. Facility activities include weekly musical performances, yoga instructor for “chair yoga”, and art therapist as well as options of nightly games. While conducting annual inspection LPA observed ukulele player performing sing a longs with residents and staff who were all engaged. The back porch of the house is shaded and provides a safe and secure area for residents to spend time outside. There were no deficiencies cited at this time. LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 12/15/2025: LIC 308 Designated (if changes) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changed) LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurance (when receive)