Routine inspection·July 30, 2025

On 07/30/25, an unannounced annual inspection was made to this facility by Licensing Program Analyst (LPA) Sommer Hayes. The LPA identified themselves and the purpose of the visit and asked to speak to the Designated Facility Administrator (DFA). LPA was met by DFA Valesia Cole and a brief interview followed. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents. The current census is 6. This facility is licensed for 6-non ambulatory residents and a hospice waiver granted for 2. LPA Hayes observed the refrigerator to be locked with a black bike lock. A fire drill was held on 05/26/25 at 2pm for 1 hour. The drill included 3 staff and 6 residents. LPA toured the facility with the DFA, Valesia Cole. The kitchen was accessible to residents and clean and sanitary. The LPA observed 7 days of non-perishable food supplies and did not observe 2 days of perishable food supplies. There were enough clean plates, cups and bowls and cutlery to meet capacity. LPA observed opened packages and storage containers with food items in the refrigerator were not dated appropriately. LPA observed a glass top stove in the kitchen. The bottom left “eye” was shattered. DFA stated the homeowner will be replacing the range. The garage was not accessible to residents. LPA observed non-perishable food items, a freezer with frozen food and other storage items. The garage was clean and sanitary. Continued on an 809-C LPA observed a malodorous odor in R2’s room. The facility living room was clean and free of obstruction. The temperature reading was 75 degrees Fahrenheit per Title 22 regulations. The seating is efficient for the number of residents in this facility. There was a fire extinguisher, smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The Medication Administration Record (MAR) was reviewed. LPA Hayes observed that R4’s melatonin medication did not have a prescription. Through staff interview this medication has been given to the resident. In addition, R3’s melatonin prescribed to be given at 3mg and through an interview with staff LPA learned that 5mg was being cut in half by staff and given to the resident. LPA reviewed 6 resident records and 2 staff records. LPA Hayes found the review of staff records to be missing required documents and incomplete. During the review of the resident records there was no documentation that the facility reported an AWOL, and a fall to the Department based on an interview with staff. LPA observed the residents’ bedrooms. There were three double occupancy rooms. LPA Hayes observed R5 and R3’s room did not have sufficient lighting. LPA Hayes observed each resident room to be without a chair, an individual night stand for each resident and a chest of drawers for each resident. LPA observed the backyard of the facility. There was a shaded area with an awning for residents to enjoy. Fencing was in good repair. The fence on the left side of the house was locked with a key lock. There were no bodies of water. LPA observed a hose that was left out in the walkway leading to the garden boxes. This could pose a tripping hazard to residents in care. Facility corrected this at the time of the visit. Based on today’s visit this Annual needs continuation. Exit interview completed with DFA and a copy of this report was provided to the DFA, Valesia Cole.