Routine inspection·August 1, 2025

On August 1, 2025, Licensing Program Analyst’s (LPA’s) Jenifer Tirre and Eboni Bentley conducted an unannounced required visit using the CARE Inspection Tool. LPA’s were greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) Jennifer Munoz arrived shortly after and was present to assist with the facility inspection on today's date. The facility is licensed for Eighty (80) Non-Ambulatory residents, of which four (4) may be bedridden with approved hospice waiver for Fifteen (15) residents. Currently, there are five (5) Hospice residents present during today’s visit. Facility is a two story building with 59 units combined in both Assisted Living and Memory Care with total capacity of 80. Facility is approved for Delayed Egress. Facility serves as a Residential Care Facility For Elderly and Dementia Residents. At around 9:00AM, LPA’s conducted a tour of the physical plant accompanied by Executive Director Jennifer Munoz, and the following was observed: There were no bodies of water on the premises. Rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bathrooms were operational with water temperature measured between 110.8 to 116.4 degrees F inside facility restrooms. A comfortable temperature of 72 degrees F. was maintained in the facility. The kitchen was inspected, and facility has sufficient perishable and non-perishable foods. Facility has Easy Meal food kits which serve 25 individuals per package for emergency food and two large water drums of emergency water. Storage areas for sharps objects and cleaning supplies were stored and not accessible to residents. Facility has multiple fire extinguishers. During today’s visit eight (8) fire extinguishers were observed to be fully charged, mounted and in compliance with date of service of November 12, 2024. Facility has total of two evacuation chairs at end of each stairwell. CONTINUED ON 809C A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. During the visit, LPA’s observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA’s observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA’s observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 7/18/2025. Facility has operating smoke detectors and audible alarms which LPA's observed Last fire inspection paperwork was completed by TRL Systems completed on March 5, 2025. Proof of liability insurance was provided during visit. The facility has current liability insurance on file effective 5/1/2025 – 5/1/2026. A review of seven residents (R1-R7) service files and eight staff (S1-S8) personnel files revealed to be complete. Interviews were conducted with staff and residents. The facility has the current administrator's certification on file for Jennifer Munoz # 7003108740 - Expiration 10/27/2025 No deficiencies during this inspection visit. An exit interview was conducted with Executive Director Jennifer Munoz , and a copy of the report was provided.