Routine inspection·November 13, 2025

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:40AM. LPA was greeted by facility staff upon arrival. Licensee Toni Dart was contacted via telephone and arrived at 10:00AM and Administrator arrived shortly thereafter. Entrance interview conducted. Facility is a single-story residence that consists of five (5) resident bedrooms and three (3) bathrooms. The LPA observed (1) fully charged fire extinguisher and last serviced on 06/23/2025. All hardwired smoke alarms and fire door were tested at 12:48PM and functioned properly during time of visit. LPA observed all required postings in the entrance of the home. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Beginning at 10:08AM, the LPA along with Licensee conducted a tour of the physical plant to ensure there are no health and safety hazards and the facility is in compliance with Title 22 regulation. The following was observed: BEDROOMS: There are 5 (five) resident rooms; 1 (one) is designated as a shared resident room and the remaining 4 (four) are designated for private resident use. The resident bedrooms were properly furnished with at least one chair, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. BATHROOMS: LPA observed all resident bathrooms clean, properly supplied and had functional fixtures. The LPA observed grab bars and slip-resistant surfaces in resident bathrooms. Residents have sufficient amounts of supplies for personal hygiene. Water temperature was measured in the private resident restroom and was 116.8 degrees Fahrenheit, which is within the required range. Report Continued on LIC 809-C COMMON AREAS: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in the living room, which is covered with a screen. The facility maintained a comfortable temperature throughout the visit. SURROUNDING GROUNDS (OUTDOORS) : There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. The side gate was observed to be self-closing and latching. All exits were clear and free of hazards. KITCHEN : The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; sharp objects are stored in a locked drawer to the left of the stove. GARAGE: The locked garage is where the washer and dryer are held. The garage also contains additional non-perishable emergency food and water, storage and personal care supplies, as well as extra food. Cleaning supplies and disinfectants are stored in locked cabinets in the locked garage. RECORD REVIEW: Beginning at 10:24AM, LPA reviewed staff and resident files for items including, but not limited to: medical assessments, TB clearance, personal rights, staff training records, health screening and personnel records. The LPA reviewed five (5) resident files and five (5) staff files. All staff files reviewed appeared complete and current. Four (4) of five (5) resident files reviewed contained needs and service plans that were dated 10/10/2024 or 11/03/2024, just over 12-months ago. MEDICATION REVIEW: Medications review began at 12:25PM. LPA reviewed medications for 2 (two) residents. Medications are centrally stored and locked in a cabinet in the kitchen area and in a lockbox in the refrigerator. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. EMERGENCY DISASTER PLAN/INFECTION CONTROL PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and updated annually, as required. Emergency drills are conducted quarterly, with the last drill documented in August 2025. No citations issued. Exit interview conducted and copy of the report was provided.