Routine inspection·February 6, 2026

Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by care giving staff after explaining the purpose for the visit. Administrator (AD) Johan "Alex" Mathews was notified via telephone and later arrived to assist with the inspection. LPA observed that Administrator Johan Mathews has a valid Administrator certificate which expires on June 13, 2026. LPA began a tour of the facility and observed the following. The facility is a two story home with five resident bedrooms, one of which is shared, one staff room, two resident bathrooms, one of which is shared, a living room, a dining room, a kitchen, and an attached two car garage. LPA observed six residents in care and two care giving staff present. LPA observed residents lounging in their respective bedrooms and in the dining room. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected the five resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed with clean linens in good repair; meaning no strains or tares, a chair, a chest of drawers, a reading lamp, and enough storage space to store personal belongings. LPA observed additional linens are stored in a closet in a resident bedroom. LPA observed Oxygen signs posted in the appropriate areas. LPA inspected resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars, slip resistant floor matts, and a shower chair. Faucets and toilets were operational. Hot water temperature measured between 114.7 and 118.6 degrees Fahrenheit. LPA observed the second story of the home is off limits to residents in care and is used for storage. LPA observed the kitchen area to be clean and free of any mildew or debris. LPA observed for the facility to have a two day perishable and seven day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed kitchen knives are stored in a locked kitchen cabinet. CONTINUED ON LIC809-C LPA Conducted a tour of the outside of the facility and observed the following. LPA observed an outdoor shaded sitting area, side doors are self latching and unlocked. LPA observed the backyard to be clean and free of any hazards and debris. Backyard is large enough to participate in outdoor activities upon resident request. LPA observed all smoke detectors and carbon monoxide detectors to be in good repair and tested operational. LPA observed all fire extinguishers to be fully charged and up to date. LPA observed first aid kit to have all required items such as a thermometer, bandages, scissors, tweezers, adhesive tape, and a first aid manual. LPA reviewed medication administration record and medications with AAD and observed all medications to be documented, and per LPA review medications are being administered per physicians orders, no discrepancies were noted. LPA reviewed two staff files, and six resident files. All files (staff and resident) have all required documents staff annual training was up to date, and documented. Based on observations made during today's inspection no deficiencies will be issued. An exit interview was conducted with AD Alex Mathews and a copy of this report was provided to the facility, and a copy will be mailed to the facility as well.