Routine inspection·September 30, 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 the visit, all residents were observed in their room during the visit, except one resident who was observed watching television. There’s a total of 6 bedrooms and 4 bathroom areas. There’s a living room space, a dining space and a detached 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 measured in between 105.2 – 106.5 degrees F. Kitchen: 4 of 4 burners and the warmer are operational on the gas stove. Sharps are kept locked in the a kitchen drawer. Cleaning chemicals are stored below the sink in a locked cabinet. Food Service: A supply of perishable and non-perishable food items that meet regulation requirements was observed. Client & Staff Files : Resident and staff files stored in locked filing cabinets near a dining table below the facility postings board. File Review: 3 of 5 resident files were reviewed during the visit, and 3 staff files were reviewed. Medications/First-Aid Kit: Resident medications and the first aid kit are stored in the locked filing cabinets near the dining table. Medication Review: 3 of 5 resident medications were reviewed during the visit. Discrepancies were noted and photos were taken. Continued on LIC809C Linens & Hygiene Supplies: Hygiene items were observed in the resident bathrooms locked below the sink and additional hygiene items were observed in the laundry room. Garage Area: The garage is used as a storage space for various supplies. Incontinent care supplies, walkers, clothing, surgical mask and an additional water supply was observed. Backyard/Exterior: . Walkways are free of obstruction. A table and chairs were observed under a patio area. Bodies of Water: Swimming pool is surrounded by a self-latching fence that measured five feet high off the ground. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted in the kitchen and in the dining room near the locked medication, and locked staff and resident files. An emergency evacuation drill: An emergency evacuation drill was conducted September 10, 2025. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Facility postings are posted are available for review on the main postings board above the locked filing cabinets where medications, and staff, and resident files are stored. Additional Comments: Licensing fees are current. Interviews with staff were conducted A resident interview was conducted. Facility contact information was reviewed, updated, and confirmed during the visit. Deficiencies are being cited as a result of today’s annual inspection. An exit interview conducted, and a copy of the report and appeal rights were provided.