Beginning at 09:45am, the LPA along with the 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: There are five (5) bedrooms for resident use. Four (4) bedrooms are designated as private / single bedrooms, and one (1) bedroom is designated as shared / double occupancy. Bedrooms were observed to be furnished appropriately and had sufficient lighting. Staff bedroom observed on premises locked and inaccessible at the time of the visit.

Restrooms: There are three (3) restroom for resident use. Bathrooms were clean and sanitary and in operating condition with non-skid surfaces and grab bars. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 09:50am, the hot water temperature was measured in resident bathrooms, and they measured within the required range of 105 – 120 degrees Fahrenheit at the time of the visit. Personal hygiene items were observed locked and inaccessible at the time of the visit.

Common Areas: This includes the living room and dining room area. Furniture in the common areas was observed to be in good condition at the time of the visit. The facility maintained a comfortable temperature.

Report Continued on LIC 809C...

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Laundry Room: Washer and dryer were observed in the laundry room. Detergents and cleaning supplies were observed locked and inaccessible to residents in care at the time of the visit.

Kitchen: The LPA inspected the kitchen/food service area at approximately 10:02am. Knives and sharps were observed in a locked cabinet. Cleaning supplies were observed locked and inaccessible under the kitchen sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates.

Outdoors: The backyard has a covered patio area with adequate furniture for resident use. Emergency passageway was observed to be clear of any obstructions. There are two (2) side gates with latching mechanisms. No bodies of water noted at the time of the visit.

Records: Record review began at approximately 10:15am.

Four (4) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, consent for treatment form, preplacement appraisals, appraisals, and current needs and services plan. All files were in order.

Five (5) personnel files were reviewed for, but not limited to: personnel records, health assessments with negative TB test results, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All personnel files were complete. The Administrator’s certificate is valid until 05/25/2027.

The LPA interviewed three (3) residents during the inspection and no concerns were noted.

Medications: Medication review began at approximately 12:30pm. Medications are centrally stored and kept in a locked cabinet by the kitchen.

Report Continued on LIC 809C...

Infection Control / Emergency Disaster Planning: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as they pertain to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; last disaster drill conducted on 05/18/2026.

No citations issued at this time. Exit interview conducted. A copy of the report was issued.