Routine inspection·October 22, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 11:20AM. LPA met with staff upon arrival and Administrator Kim Anderson who arrived shortly thereafter. Entrance interview conducted. Beginning at 11:30AM, the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN/LAUNDRY: At 11:30AM, LPA inspected the kitchen/food service area. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility had a sufficient supply of perishable and non-perishable food. Knives, sharps, cleaning supplies, and disinfectants are stored inaccessible in locked cabinets and drawers. The laundry unit is adjacent to the kitchen and detergents were maintained locked and inaccessible. GARAGE: The garage is maintained locked and inaccessible. LPA observed incontinence supplies, an additional refrigerator/freezer, and a emergency food and water supply. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private resident rooms and one (1) is designated as a staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All resident bedrooms have exits to the exterior and were equipped with functional auditory exit alarms. Report Continued on LIC 809-C. BATHROOMS: There are four (4) bathrooms. Three (3) are designated for resident use and one (1) is a staff/guest restroom. LPA observed bathrooms to be clean, sanitary, and in operating condition with slip-resistant surfaces and grab bars. Hot water temperatures were measured in resident bathrooms and were between 109.2-111.2 degrees F, which is within the required range. COMMON AREAS: These include the living room and dining area. Common areas were appropriately furnished and in good condition. The facility maintained a comfortable temperature. Smoke detectors, fire doors, and carbon monoxide detector were tested at 11:59AM and were operable. LPA observed a fire extinguisher which was fully charged and purchased on 06/03/2025. Required posters were displayed throughout the common areas. Activities were observed in the common areas. A non-functional fireplace was noted in the living room. OUTDOOR AREA: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate that was equipped with a functioning alarm. There were no bodies of water noted at the time of the visit. MEDICATIONS: Medications review began at 11:50AM; medications are centrally stored and kept inaccessible in a medication cart by the laundry unit. LPA reviewed medications for two (2) residents. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs were properly documented and logged. Medications were observed to be properly documented on the centrally stored medications and destruction record and were in compliance with regulation, state, and federal law. RECORD REVIEW: LPA began record review at 12:10PM. LPA reviewed five (5) out of five (5) resident files for documents including, but not limited to: appraisals, medical records, admissions agreement, and consent forms. LPA reviewed four (4) personnel records for documents including, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All resident and personnel files were in order and had no missing documents. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually. Emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 09/18/2025. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.