Routine inspection·July 28, 2025

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced at 9:55 a.m. to conduct a required annual visit. The LPA entered the facility and was greeted by staff and Administrator Dvora “Debbie” Leventer. The reason for the visit was explained. Entrance interview. The facility is cleared for 6 bedridden residents. The fire clearance was granted on 6/21/2023; in which bedridden residents are permitted in Bedroom B thru G. At 10:01 a.m., the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. At 10:50 a.m. hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 11/07/2024. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 07/11/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility and was informed by the Administrator that all the cameras are inactive. Report Continued on LIC 809-C PAGE 2 ... (PAGE 2) Report Continued from LIC 809-C... INTERVIEWS : Starting at 10:20 a.m. two (2) staff and five (5) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interview revealed that no concerns were noted or voiced at the time of the visit. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident bedrooms and one (1) is designated as an office where files are stored. The office is kept locked. All rooms A-G have direct access to the outside. All passageways were observed to be clear of obstructions. All resident rooms were set up with beds, night stands, lighting, chests of drawers, chairs and closet space. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS : There are seven (7) total restrooms. One (1) is designated as a staff / guest restroom, and six (6) are designated as private resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in all restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 111.0-116.2 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. KITCHEN: The LPA inspected the kitchen/food service area at 10:30 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 116.6 degrees Fahrenheit at 10:32 a.m. Cleaning supplies and other chemicals are kept in the laundry room locked and inaccessible to residents in care. LPA observed an adequate amount of emergency food and water located in the food pantry. LAUNDRY : The laundry area is adjacent to the kitchen and kept locked at all times. Laundry detergent and other chemicals are stored in the laundry area inaccessible to residents in care. Report Continued on LIC 809-C PAGE 3 ... (PAGE 3) Report Continued from LIC 809-C PAGE 2... EXTERIOR : The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located directly outside the sliding doors from the kitchen. There is a common recreational area with additional covered patio area with furniture and a mini golf area for resident use. There were no bodies of water noted at the time of the visit. There is a self-latching gate located on the side passageway. There is no front yard gate or driveway gate. The garage is attached to the property and is used for additional storage. There are 3 other structures on the property which are licensed individually as part of the same ownership. RECORDS: Record review began at approx. 10:50 a.m . Resident Records were reviewed beginning at 10:55 a.m. Five (5) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Personnel Records were reviewed beginning at 11:56 a.m. four (4) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures, as they pertain to infection control and emergency planning, are satisfactory. MEDICATIONS: Medication review began at approximately 12:05 p.m. Medications are centrally stored and locked in a closet in the main hallway, adjacent to the kitchen. Medications for three (3) out of five (5) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.