Post-licensing visit·April 21, 2026

On 04/21/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced pre-licensing inspection visit. LPA met with administrator Katie Eiseman and explained the purpose of today's visit. There are currently 5 residents and 2 staff working on this day. Administrator is present making it 2 staff in the facility at time of post-licensing inspection. This is a single level facility approved all residents to be non-amblatory and three hospice residents per the previous license. There are currently 2 residents under hospice care. Per fire clearance the facility is cleared for all non-ambulatory residents. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer between the stove and refrigerator. Medications are observed to be locked in a lockable storage area in the office of the facility. Perishable and non-perishable food items are observed as in place. There are additional refrigerators and freezers in the garage area which also carry additional food supplies. First aid kit is observed as complete with required items located in the office area of the facility. LPA observed that there are multiple fire extinguishers in place inspected 08/19/2025, smoke detectors, carbon monoxide detectors are observed in place through out the facility, and central heating system. PPE and additional food supplies are observed as in place. Laundry area is also observed as fully operational. Continued on next page... Page 2 Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted in 03/16/2026. Water temperature was measured at 114F in two common resident bathrooms and a private bathroom in Room 6. LPA observed resident rooms at random and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Three resident bedrooms contain access to a full bathroom. Resident linen supplies are observed as in place. Cleaning supplies are also observed as locked inaccessible to residents in care primarily being stored in the garage. There is a live in staff area for sleeping also located in the office. Facility does not handle resident monies. Resident files and staff files are reviewed as current. Medications are inspected and observed to be current and in order. Administrator certificate is observed to be current expiring on 01/07/2027. No citations issued during today's visit. Report is reviewed with Thomas Eiseman.