Routine inspection·October 28, 2025

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 six non-ambulatory residents, of which one may be bedridden. As of today, the facility has five residents admitted to the facility. All of the residents were present during at the beginning of the visit, before one left for day program. There’s a total of 5 bedrooms (3 resident & 2 Staff) and 2 bathroom (1 resident & 1 staff) areas for residents. There’s a living room space, a dining space, backyard and an attached garage. 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 was measured at 106.8 degrees F. Kitchen: 4 of 4 burners are operational on the gas stove. Sharps are kept locked under the sink. Cleaning chemicals are stored in a locked cabinet above the washer. A dryer is located in the kitchen across from the washer. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. Client & Staff Files : Resident and staff files are stored in the locked closet near the entrance of the facility. File Review: 4 of 5 resident files were reviewed during the visit, and 3 staff files were reviewed. Medications/First-Aid Kit: Resident medications are stored in the locked medication closet. A first aid kit was also observed. Medication Review: 3 of 5 resident medications were reviewed during the visit. Continued on LIC809C Linens & Hygiene Supplies: Hygiene items were observed in the bathroom areas in a locked cabinet space. Garage Area: The garage is used as a storage area. Miscellaneous facility items were observed, like bed frames, mattresses, wheelchairs, walkers, and a bike. Staff items are stored in locked storage areas along the outer edges of the garage. The Licensee/ was advised to keep walkways clear and free of clutter. Licensee understood and showed LPA recently bout shelves that will be assembled in the garage to help keep it organized. Backyard/Exterior: The backyard has a shaded patio area with a table and chairs. There were furniture items no longer being used under the patio area that need to be removed. Photos were taken. Other deficiencies were observed and photographed. See LIC9099D dated (10.28.25). LPA discussed other backyard housekeeping needs, that will assist in preventing future violations. The licensee/Administrator understood. Bodies of Water: None. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted in the kitchen. An emergency evacuation drill: Evacuation drills was conducted July 19, 2025. Drills are conducted quarterly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Facility postings are posted are available for review on the main postings board at the entrance of the facility. Additional Comments: Licensing fees are current. During the visit, 3 of 5 resident files were reviewed, 3 of 5 resident medications were reviewed and 3 staff files were reviewed during the visit. Facility contact information was updated during the visit. Deficiencies observed during the inspection will be cited. An exit interview conducted, and a copy of the report and appeal rights were provided.