Routine inspection (multi-day)·October 2, 2025

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced annual continuation visit to continue the annual inspection started on 9/22/2025. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Roy Antes. The facility is licensed for a maximum capacity of 6 residents, 1 ambulatory, 5 non-ambulatory, 1 of which may be bedridden in bedroom #6. The facility has a waiver for 5 hospice residents. During today’s visit, the facility had a census of 6 residents, 2 of which (Residents 1 and 2) were bedridden due to being unable to reposition independently, which is in violation of the facility's approved fire clearance. [Staff were provided with an LIC811 Confidential Names List to identify R1 and R2] Interviews with staff and residents revealed that Administrator Lynn Drummond is not present at the facility enough hours to oversee its operation, and it was estimated that Drummond was present at the facility approximately once a month. During visits on 9/22/25, 9/25/25, and 10/2/25, LPA toured the facility and inspected each room of the facility, including resident and staff rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 106.4 and 108.7 degrees Fahrenheit in bathrooms for resident use and 111.2 degrees Fahrenheit in the kitchen sink. The facility’s internal temperature was measured at 76 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Raymond Abedoza, no firearms or weapons are stored on the premises. Continued on LIC809-C page… LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and labelled. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 42 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. LPA reviewed multiple resident and staff records. The following deficiencies were cited for Administrator presence and over-capacity for bedridden residents and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $500 was assessed for over-capacity for bedridden and noted on the attached LIC421IM form. An exit interview was conducted with Caregiver Raymond Abedoza, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).