Routine inspection·December 22, 2025

On December 22, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. House Manager (HM) Madison Shelley was present, and Licensee (LI) Alan Shelley later arrived to assist with the inspection. LPA observed that Alan Shelley has a valid Administrator certificate which expires on March 24, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a one story home with six private resident bedrooms, three shared resident bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the HM, conducted a tour of the interior portions of the facility. On today's visit, there were six residents in care and two care giving staff present. LPA observed the resident relaxing in the living room and in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all six resident bedrooms and they were observed to be free of any hazards. LPA observed the resident bedrooms had all the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens and blankets are stored in a hallway closet. LPA inspected the three shared resident bathrooms. Resident bathrooms are clean. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 112.2 and 117.6 degrees Fahrenheit. LPA observed that the kitchen has a two day perishable and a seven day nonperishable food supply on hand. Kitchen appliances were clean and operational. LPA observed the five burner gas stove lights unassisted. CONTINUED ON LIC809-C LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed toxins and chemicals to be stored in a locked kitchen cabinet under the sink. A fire extinguisher is located in the kitchen and it was observed to be charged and purchased on November 29, 2025. LPA tested the individual smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 20, 2025. The centrally stored medication is kept in a locked cabinet located in the kitchen. LPA observed a First Aid Kit to be stored in the kitchen and it had all the required components. LPA observed the door leading to the attached two car garage to kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the HM, conduct a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gates of the facility are self-latching and can be open in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. LPA observed that there was no Medical Assessment on file for Resident #5 (R5). LPA reviewed the residents' medication and medication administration record. LPA reviewed five staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, one deficiency is being cited on the attached LIC809-D. An exit interview was conducted with House Manager Madison Shelley. A copy of the report and Appeal Rights were provided.