Routine inspection·April 25, 2025

On 4/25/25, at 1:30 the Licensing Program Analysts(LPAs) Noel Wolf Petersen and Michael Bilger arrived unnannounced to the facility, to perform an annual inspection. They met with licensee Maxima Martin, and explained the purpose of the visit. This facility is licensed as a Residential Care Facility for Elderly adults a capacity of 6 and a current census of 6. There are zero (0) on oxigen administration, one (1) that is bedridden, four (4) that were on hospice, four (4) that have dementia, and two (2) that are utilizing home health care worker services. The facility Physical Plant was inspected, including but not limited to the kitchen, storage areas, exterior, recreation common area, hallways, resident bedrooms and resident bathrooms. No bodies of water were observed. The required posters were displayed including the ombudsman, federal work poster, and the rights poster. The bedrooms had the required furnishings, and lighting was observed on the way to the bathroom. The premises including the fire exits were free of obstruction. The physical plant is clean and in good repair. The first aid kit was inspected and found to have all the required items, the fire extinguisher was dated 1/2/25 and the resident water temperature measured in the bathroom was within the 105-120*F range per regulation. 2 days of perishable food was observed, 7 days of non-perishable food was observed and in compliance with regulation. Sharps and toxics were locked and stored away from food, inaccessible to residents. The medication storage was locked. Fire alarm was in working order, and fire drills are up to date through last quarter. Phones are in working order and clients have the capacity to take private calls. Continued on C page. The staff records and client records were requested for review, the admission agreement, training documents, plan of operation, infection control plan, first aid documentation, fingerprint clearance for background checks, were found to be complete and in compliance. The client's needs and services plans that designated particular forms of care were met to specification outlined in the documents. An exit interview was conducted with the Licensee and the copy of the report was read and given to the staff.