Routine inspection·September 18, 2025

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Katherine Borja followed by Administrator (Admin) Tyana Fisk after stating the reason for the visit. The administrator's certificate for Tyana Fisk is valid expiring on May 29, 2026. The following was observed during the inspection: This is a single story property located in a residential neighborhood comprised of six private resident bedrooms and four resident bathrooms. Facility operates within the conditions and limitations specified on the license. LPA observed six residents in care with four residents receiving hospice service. LPA observed two caregivers on duty and verified fingerprint clearance and association statuses for the caregivers and administrator. All common areas were inspected including the attached garage which was converted into an office/storage and resting area for staff evidenced by the two mattresses in which the alteration occurred approximately 2020 per administrator. The two spaces in the garage share a wall which was built during this time. LPA toured the interior portion of the facility. The fireplace is properly screened. LPA observed and inspected the six private resident bedrooms what used to be five private resident bedrooms and one staff bedroom per administrator and review of the initial/current facility sketches. LPA observed that the caretaker's suite is now occupied by Resident #5 (R5). The resident bedrooms' were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. All bathrooms were found be in compliance, clean, and operational. The hot water temperature measured within range at 113.0, 116.2, 116.6/116.7 (shared), and 113.3 degrees Fahren heit in the bathrooms. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The two exit gates on each side of the property were operational and there were sufficient seating and shading in the patio area. The fire extinguisher was mounted, charged, and serviced on June 9, 2025. The auditory devices and smoke/carbon monoxide detectors were tested and operational. LPA observed the emergency food/water and supplies in the kitchen. The first aid kit had all necessary elements. Emergency drills were conducted once this year with the last date on April 21, 2025. LPA observed the required 'See Something, Say Something' (PUB475) poster posted in an incorrect size in the entry way. LPA interviewed two out of six residents as residents were sleeping or participating in an activity. One out of two staff interviews were conducted as the second staff was preparing dinner. LPA reviewed six out of six resident files and three personnel files in which no discrepancies were found. Medications were audited for two out of six residents in which no discrepancies were found. Admin was advised on the following: to conduct quarterly disaster drills and to enlarge the PUB475 that meets the 20" x 26" requirement. Admin was also advised that LPA may follow up on a later date regarding the structural changes. Based on the observations made during today's visit, no deficiency is being cited. Advisory Notes are being issued. An exit interview was conducted with Administrator Tanya Fisk, and a copy of this report was provided at exit.