Routine inspection·August 21, 2025

On August 21, 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. Administrator (AD) Annette Winters was present to assist with the facility inspection on today's date. The facility is licensed as a Residential Care For The Elderly (RCFE) home aged 60 and over with capacity of six (6). Facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for two (2) residents. Currently, there are zero (0) Hospice residents present during today’s visit. This is a single story with a detached garage facility. The facility has three bedrooms and two full bathrooms. LPA conducted a tour of the physical plant accompanied by Administrator Annette Winters, 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, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 108.1 degrees F. A comfortable temperature of 74 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. Facility has supply of emergency food and water. Facility has one fire extinguisher which was fully charged and mounted. A review of the Medication Records Administration (MAR) was conducted and LPA observed the records are in compliance. CONTINUED ON 809C During the visit, LPA observed the facility's infection control practices. LPA observed the facility has a supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on July 8, 2025. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 10/3/2024 – 10/3/2025. A review of four residents (R1-R4) 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 Winters, and a copy of the report was provided.