Routine inspection·December 16, 2025

On 12/16/2025, Licensing program Analyst (LPA) Jaime Vado conducted an unannounced required - 1 year inspection. LPA met with Administrator/licensee Maria Comfort and explained the purpose of today’s visit. Currently there are 6 residents and 3 staff present including the administrator. This is a single level facility with 6 bedrooms for residents. The facility is licensed for age 60 and over; 6 Non-Ambulatory residents only; Hospice waiver granted for 2 residents. There are no hospice residents at this time. LPA Vado toured the facility both inside and outside with Maria. All outdoor and indoor passageway are free and clear of obstructions for emergency exit routes in case of fire or emergency. Facility's ambient temperature is comfortable for residents and LPA. No pools or bodies of water were observed during today's visit on the premises. LPA observed fresh food supplies and emergency one week of nonperishable and two (2) days of perishable foods as in place. There are refrigerators with freezers located in the garage and kitchen. Canned food supplies are primarily observed as stored in the garage. Knives are locked in the kitchen in a drawer next to the stove. Lunch is being prepared during today's visit. Toxic chemicals are stored in the laundry room in upper cabinets. Cleaning supplies and laundry soaps and items are also locked in these cabinets. PPE and incontinence supplies are observed to be in place in case of any use. Medications are locked in the laundry room in upper cabinets as well separate from the cleaning and supplies. Each client room observed contained the required furniture as outlined in regulations. Facility has functioning smoke detectors and carbon monoxide detectors. The facility is equipped with private half bathes in each resident room and a common shower room is located in the hallway. All are observed in good working order for resident use. Water temperature is tested at 112F in resident room half bath. There are two fire extinguishers in the facility that is observed with inspection tags of 09/15/2025. Continued on next page... Page 2 LPA observed resident linen supplies and incidentals also store in a hallway closet. Shower room floor is equipped with non-skid mats when in use. LPA inspected the medications and files of 3 residents in care at the facility. Based on review of all resident files, and medications all items are current and logged accurately. Staff files are reviewed, and of the reviewed files conducted randomly, staff files are current and associated appropriately and have current finger print clearances. Last fire/disaster drill was conducted on 05/15/2025 per records reviewed. Administrator certificate is observed to be current expiring of 08/31/2026. The following updated forms are requested to be submitted to CCLD by 01/14/2026 : • Copy of updated administrator certificate • LIC308 Designation of responsible staff person • LIC500 Staff Schedule There are no citations issued during today's inspection visit. Report is reviewed with Maria and a copy is provided on this day.