Routine inspection·August 14, 2025

Licensing Program Analyst (LPA) Rankin arrived at 9:35 am and made an unannounced 1-year required annual visit to the facility above. LPA met with Shirley Oani, administrator and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Physical Plant & Environment Safety: The facility has 4 bedrooms and 2 bathrooms currently occupying 6 residents. The facility has smoke and carbon monoxide detectors that were tested and working at time of visit. The lighting is sufficient for the use of the facility and for resident comfort. The toilet, hand washing and bathing facilities are operational and secure grab bars are present. The showers have non-skid mats and/or flooring. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant and cleaning solutions are inaccessible to residents in care and additional measures are being implemented. There is sufficient space inside and outside for activities and visiting. The facility has a fenced backyard for client use with some shade. The fire extinguisher was inspected on 8/7/25. Operational Requirements: The facility has current liability insurance that expires on 1/9/26. The facility is approved for a capacity of 6. The fire clearance is granted for 6 non-ambulatory residents. A hospice waiver is approved for 2 residents. Personnel Records & Training: The facility currently employs 4 full-time caregivers, 2 of which are administrators and back-up caregivers are available. Staff records are kept confidential. Files reviewed for, but not limited to current 1st Aid/CPR, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions all files complete. Administrator’s Certificates expires 5/9/26. Staff have annual training completed for various subjects/topics and hours for 2025. Continued 809-C Resident Records & Incident Reports: Resident files are kept confidential. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for but not limited to signed Admission Agreements, Physicians reports, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all files were complete. Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. All food is covered, stored, and marked appropriately. Cleaning solutions and equipment are stored separately from food supplies. Incidental Medical Services: Facility provides and/or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducted a quarterly disaster drill 6/20/2025. Emergency exits and telephone numbers were posted. Residents with Special Health Needs: The facility does accept dementia residents in care. The facility does not have delayed egress, locked doors or gates. Exit door alarms are working. Exit interview conducted and copy of report printed for Administrator.