Routine inspection·July 21, 2025

On July 21, 2025, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Licensee, Jo Ann Wright, and disclosed the purpose of the inspection. The Licensee informed the LPA that the facility had one (1) resident in care and one (1) staff member present at the time. The resident was away at their day program. LPA initiated a walk-through of the facility, accompanied by the Licensee. LPA inspected the kitchen with no cooking in progress at the time. The appliances were checked and observed to be in working order. LPA inspected a locked cabinet containing knives and sharp objects. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for two (2) days and nonperishable staples for seven (7) days were observed. No expired food or stored medications were noted. LPA inspected the dining area adjacent to the kitchen. The dining table and chairs were observed to accommodate the residents. LPA inspected the living room with all furniture in good repair. There were sofas, a recliner chair, a covered fireplace, and a television in the living room. LPA inspected the fire extinguisher mounted on the wall in the hallway and found it fully charged, with the last service tag dated 05/06/2025. The Licensee tested the smoke and carbon monoxide detector located in the hallway in LPA’s presence, and it was found to be functional. Additional smoke detectors were observed in the bedrooms and common areas of the facility during the visit. Continued on LIC809-C There were three (3) bedrooms and found them clean, well-lit, and equipped with the required furniture. LPA inspected two (2) full bathrooms and found them sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip mats. The hot water temperature at the sink faucet measured 118.8F in bathroom #1 and 119.3°F in bathroom #2. LPA inspected the two (2) storage closets in the hallway and observed that they contained clean linens. LPA inspected the garage and observed a washer and a dryer. LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. No bodies of water were noted. LPA reviewed one (1) staff personnel records and one (1) resident records. LPA observed that one (1) of one (1) resident had an Admission Agreement, Physician's Report, and CSDMR. LPA observed that one (1) of one (1) staff members had current First Aid certificates, LIC 508 Criminal Record Statements, and LIC 503 Health Screenings, and confirmed that one (1) of one (1) staff member as associated with the facility. LPA observed a centrally stored medication cabinet located in the dining area. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 05/03/2025. The following updated forms are requested to be submitted to CCLD by 07/28/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Licensee. A copy of this report was left with the Licensee, Jo Ann, whose signature on this form confirms receipt of the report.