Routine inspection·September 16, 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 five non-ambulatory residents, one of which may be bedridden. As of today, the facility has four residents admitted to the facility. All four residents were present during the visit. There’s a total of 3 bedrooms and two bathrooms. There’s a living room space, a dining space 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, shower, and grab bars. Hot water measured in between 106.1 – 118 degrees F. Kitchen: 4 of 4 burners were operational on the gas stove. Sharps are kept locked in a cabinet below the sink. Chemicals are locked in the cabinet next to the sharps directly below the sink. 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 the living room area, in locked cabinets. File Review: 3 of 4 resident files were reviewed during the visit, and three staff files were reviewed. Medications/First-Aid Kit: Resident medications are stored in a locked medication cabinet that is stored in the dining room area. Medication Review: 3 of 4 resident medications were reviewed during the visit. Continued on LIC809C Linens & Hygiene Supplies: Additional hygiene items were observed in a cabinet in the garage. Garage Area: The garage is clean and well organized. The walkways were free of obstruction. A washer and dryer was observed. A cabinet with an emergency food supply was observed. An additional supply of hygiene items was observed. Backyard/Exterior: A shaded area with tables and chairs was observed. An ADU is currently being constructed and is expected to be completed in the next two months. Licensee/Administrator emailed LPA the building permit for the construction. In addition to the ADU, there is an additional space with a room and full bathroom for staff that remains locked and inaccessible to the resident in care. Two storage barn like structures were observed which are used to store miscellaneous facility items. Both storage areas remain locked and are inaccessible to residents in care. Bodies of Water: None. Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational. Fire Extinguisher: Fire extinguisher was observed mounted on a wall in the kitchen. An emergency evacuation drill: Has not been conducted since 2024. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted are available for review on the main postings board in the dining room. Additional Comments: Licensing fees are current. During the visit, 3 of 4 resident files were reviewed, and medications were reviewed for 3 of 4 residents. 3 staff files were reviewed during the visit. Deficiencies are being cited as a result of today’s visit. An exit interview conducted, and a copy of the report and appeal rights were provided.