Routine inspection·July 25, 2025

On July 25, 2025, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by staff and granted entry after stating the purpose of the visit. Administrators (Admin) Pauline Khiev and Annette Winters were present to assist with the facility inspection on today's date. The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for four (4) residents. Currently, there are two (2) Hospice residents present during today’s visit. This is a single story with a detached garage facility. The facility has four bedrooms (two shared and two private) and two full bathrooms and one half restroom. At around 1:15PM, LPA Tirre conducted a tour of the physical plant accompanied by Administrator Pauline Khiev and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 108.5 degrees F. A comfortable temperature of 75 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA observed facility has two fire extinguishers charged and mounted. CONTINUED During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated department posters were posted. LPA observed a working landline phone was operational. The last fire drill was conducted on 5/4/2025. The facility had operational smoke and carbon monoxide in bedrooms and common areas. A review of three residents (R1-R3) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification on file for Annette Winters # 7029071740 - Expiration 11/28/2026. No deficiencies during this inspection visit. An exit interview was conducted with Administrator Annette Winters, and a copy of the report was provided.