Routine inspection (multi-day)·October 17, 2025

Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conclude the required annual licensing inspection that commenced on October 16, 2025. LPA was met by Licensee Withers, identified herself, was granted entry into the facility, and stated the purpose of today’s visit. The facility is licensed to serve 6 residents, age 60 and over, of which all 6 can be non-ambulatory, and two bedridden, and approval for two residents receiving hospice services. During today's visit there were 6 residents and 4 staff present. A review of facility, staff, and resident records were observed to be complete and up to date. The facility’s Limited Liability Company (LLC), liability insurance, and the Licensee and their designee Administrative Certification were all current and active. LPA Correia, accompanied by Licensee Withers, also conducted a tour of the interior and exterior of the facility. At the time of the tour the facility’s ambient temperature was 77 degrees Fahrenheit. Hot water taps used by residents in care measured from 114.3 to 119.5 degrees Fahrenheit. Disinfectants, cleaning solutions, and poisons were inaccessible to residents. All residents’ rooms were equipped with the required furnishings. Resident bathrooms were observed to be sanitary and equipped with the required supplies, including grab bars and non-slip mats in the showers. LPA observed smoke alarms, and carbon monoxide detectors throughout the facility that were in operable condition. [Continued on LIC 809C] [Continuation of LIC 809] LPA also observed required postings, first aid kit and manual, and landline. The fire extinguishers were present and current on inspections. The facility’s outdoor area was free from obstructions and had a shaded area and sufficient space for activities and visits. Per Licensee Withers there are no weapons and/or ammunition housed in the facility, nor does the facility have any bodies of water on the premises. The facility is stocked with a 2-day supply of perishable and 7-day supply of nonperishable food items. The food was observed properly stored. Medications were stored in a locked cabinet. The facility's last disaster drill was conducted in September of 2025. LPA observed a sufficient supply of PPE. Based on today's visit, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with Licensee Withers and will be provided with a copy of this report and licensee/appeal rights (LIC 9058 01/16), and their signature on this form acknowledges receipt of these documents.