Routine inspection·April 28, 2026

On 4/28/2026 at 10:00 am, Licensing Program Analyst (LPA) Toni Nwala made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Facility Manager, Nadine Garcia who was informed of the purpose of the visit. Licensee also arrived to the facility shortly after arrival. The facility has a fire clearance to serve six (6) non-ambulatory elderly residents. The facility also has an approved hospice waiver for four (4) and LPA was informed two (2)of the residents are currently receiving hospice services. LPA toured the facility with Facility Manager, Nadine Garcia and observed the facility is made up of a one story home with five (5) resident bedrooms, two (2) bathrooms, a kitchen, dining area, living room, laundry room, and attached garage. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. No bodies of water were observed on the premises. Indoor and outdoor pathways were free of obstruction. The facility had a two day supply of perishable foods and seven day supply of non-perishable foods. Medications and cleaning solutions/disinfectants are separately stored in different cabinets in the locked laundry room. Continue on 809-C LPA toured the garage and observed an additional food and emergency water. The facility has a room with additional incontinent supplies, blankets, linens, and pillows and emergency food. Licensee tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed a charged fire extinguisher mounted near the kitchen last serviced on 03/10/2026.Staff present has a criminal record clearance and a valid first aid/CPR certification. Resident files reviewed had updated physician's reports and personal rights. Licensee Kelly Hentzen informed LPA admission agreement was kept in a separate place due to confidentiality. LPA reviewed the facility's Emergency Drill Participation Time sheet noting the facility's last fire drill was conducted on 3/31/2026. LPA checked water temperature and reading is 113.5 F. Long Term Care Ombudsman's contact information, complaint procedures, and facility sketch are visibly posted in a hallway. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Hentzen.