Routine inspection·February 3, 2026

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility is a single level structure and licensed for non-ambulatory residents, and has a hospice waiver for four. As of today, the facility has four residents admitted and 4 of 5 residents were present during the visit. There’s a total of 5 bedrooms of which 4 bedrooms are for the residents and one bedrooms is for staff. There are two restrooms available. There’s a living room space, a dining space and the attached garage as been converted into an ADU. Bedrooms: All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured in between 113 – 115.5 degrees F. Kitchen: All burners and the warmer were operational on the gas stove. Sharps are kept in a locked cabinet under the sink. Cleaning solutions and dish soaps are stored in the kitchen directly below the sink. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. An additional refrigerator was observed, and an additional pantry areas well stocked with nonperishable items. Client & Staff Files : Resident and staff files stored in cabinets behind the dining table. File Review: 3 of 5 resident files were reviewed during the visit, and three staff files were reviewed. Medications/First-Aid Kit: Resident medications are stored in a medication closet cabinet across from the kitchen. Continued on LIC809C Medication Review: 3 of 5 resident medications were reviewed during the visit. Linens & Hygiene Supplies: Additional hygiene items were observed in a hallway closet. Garage Area: Has been converted to an ADU. Backyard/Exterior: The backyard is clean and very well organized. Walkways are free of obstruction. A table with some chairs was observed under a shaded area. Two locked storage sheds were observed, one shed was used to store incontinent care supplies, and the other shed is used to store miscellaneous resident care items. Bodies of Water: None Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted on a wall in the kitchen. An emergency evacuation drill: Was conducted December 5, 2025. Evacuation drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted are available for review on the main postings board near the dining room. Additional Comments: Licensing fees are current. Facility contact information was updated during the visit. The emergency disaster plan was reviewed during the visit. Emergency disaster bags are present with first aid supplies. No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.