Routine inspection·September 18, 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, one of which may be bedridden. As of today, the facility has six residents admitted to the facility. All residents were present during the visit. There’s a total of 4 bedrooms and two restrooms available. 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, and shower. Kitchen: 4 of 4 burners and the warmer were operational on the gas stove. Sharps are kept locked cabinet near the sink. Cleaning solutions are stored in a locked cabinet 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 a locked cabinet across from the dining table. . File Review: 3 of 6 resident files were reviewed during the visit, and 3 staff files were reviewed. Medications/First-Aid Kit: Resident medications are stored in a locked medication cabinet in the kitchen. Medication Review: 3 of 6 resident medications were reviewed during the visit. Continued on LIC809C Linens & Hygiene Supplies: Hygiene items were observed in a locked cabinet below the sink in the main bathroom. Garage Area: The garage is organized and used mainly as a storage area. A washer and dryer was observed. An additional refrigerator with a nonperishable food supply was observed. Miscellaneous facility items were observed: matts, couch, extra stove, as well as clothing and other items. Backyard/Exterior: The backyard is clean and organized. Walkways are free of obstruction. A table with some chairs was observed under a large sunshade. 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 near a sliding door that leads to the backyard. An emergency evacuation drill: September 1, 2025. Evacuation drills are conducted monthly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted, and available for review on the main postings board across from the dining table. Additional Comments: Licensing fees were paid during the visit, and a copy of the receipt was provided. The facility telephone number was provided and the secondary number confirmed. During the visit, 3 of 6 resident files were reviewed, and medications were reviewed for 6 of 6 residents. 3 staff files were reviewed during the visit. No deficiencies are being cited during today’s visit. An exit interview conducted, and a copy of the report was provided.