Routine inspection·April 6, 2026

Licensing Program Analyst (LPA) De Leon conducted a 1 year annual visit to the facility above. LPA met with Susan Sevior and explained the purpose of the visit. The facility does not have any residents in care at this time. The facility is set up for dementia residents in care. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility Infection Control Plan is on file. The bathrooms have toilet paper, paper towels, and hand soap. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms if needed. Staff will be trained on infection control and the use of Personal Protective Equipment (PPE) upon hire and annually there after. Physical Plant & Environment Safety: The facility is a 4 bedroom and 2 bathroom, 1 bedroom has on suite bathroom and is designated for Licensee only. The facility does not have any residents in care. The staff are currently the Administrator and Licensee. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has dual smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in garage. The facility has sufficient space inside and outside for activities and visiting. The facility has a small back and front patio with furniture and a side yard for residents use. The facility has cell telephone number and internet service for resident use. Water tested at 112.5 F. Continued 809-C Operational Requirements: The facility has a current plan of operation on file. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance. The facility is approved for a capacity of 6 of which 2 may be non-ambulatory in room #1 and room #4 only. Staffing: Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate expires 05/17/2026. Personnel Records & Training: The facility keeps confidential files for staff. Staff will be trained upon hire. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Files will have required records upon the residents admission to the facility. Incidental Medical & Dental: The facility has a locked cabinet for medications. The facility will use the MAR and CSMDR forms upon getting residents in care. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. An emergency supply of food and water will be available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Disaster Preparedness: The current emergency disaster forms were posted. The fire extinguishers was charged in the green. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not have delayed egress. The facility does not currently have residents with oxygen. The facility does not currently have hospice residents in care. Hospice care plans will be kept on file. The facility does not currently have residents on Home Health services. Home Health services records will be kept on file. Exit interview conducted and copy of report printed for Licensee.