Post-licensing visit·March 24, 2026

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced post-licensing visit to this facility at 02:00PM. LPA initially met with staff. Administrator was contacted via telephone and arrived at 02:15PM. Entrance interview conducted. Beginning at 02:23PM, the LPA, along with 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. The following was observed: BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are six (6) total bedrooms, all of which are designated for private resident use. RESTROOMS: The LPA observed four (4) restrooms in the facility; two (2) are shared restrooms, including one (1) for guests and one (1) for residents and two (2) are designated for private resident use. Resident restrooms were observed to be clean and sanitary and in operating condition with grab bars and slip resistant surfaces. Water temperature measured within the required range. COMMON AREAS: Facility common areas include the living room and dining room. All common areas were observed to be clean and properly furnished. Auditory alarms on exit doors functioned properly. OUTDOOR SPACE: The back yard area is enclosed. The backyard contains a shaded seating area and appropriate outdoor furnishings, as well as outdoor activity supplies. All passageways were observed to be clear and the outdoor area free from hazard. Report Continued on LIC 809-C KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives and other sharps were observed locked in a kitchen drawer. Cleaning supplies were observed in a locked cabinet. Fire extinguisher was observed to be fully charged and purchased just prior to the facility opening. RECORD REVIEW: Began at 02:40PM; all staff and resident records are stored electronically. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Five (5) resident records reviewed were complete and contained all required documents. Three (3) staff files were reviewed; all staff files reviewed were observed to be in compliance. MEDICATION REVIEW: Began at 03:50PM. Medications for two (2) residents were observed. No discrepancies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control practices. 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. Emergency disaster drills will be conducted quarterly. INTERVIEWS: Throughout today's visit, LPA interviewed residents and staff. No concerns were noted. No citations issued. Exit interview conducted. A copy of today's report was provided.