Beginning at 9:10 a.m., 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:

KITCHEN: The LPA inspected the kitchen/food service area at approximately 09:15 a.m. Knives and sharps were observed locked and inaccessible in a kitchen drawer. 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. Cleaning supplied were observed under the kitchen sink locked and inaccessible at the time of the visit.

COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed multiple fire extinguishers throughout the facility to be fully charged with a purchase date of 07/31/2025. Required postings were observed throughout the common space. There is a working telephone on premises. The LPA observed an adequate amount of emergency food and water. Washer and dryer were observed. Detergents were observed inaccessible to residents at the time of the visit. No hazards/obstruction observed inside or out.

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.

BEDROOMS: There are three (3) total bedrooms in the facility; all bedrooms are approved for double occupancy. Resident rooms were observed to be furnished appropriately. The LPA observed a staff bedroom on premises.

BACKYARD: The backyard has a covered patio area with patio furniture for resident use. All passageways were observed to be clear of any obstructions. There is one (1) side gate with latching mechanism. The LPA observed an empty pool locked and inaccessible at the time of the visit.

RECORDS: The LPA began record review at approximately 09:33 a.m.

Two (2) 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 files were in order.

Three (3) 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 yearly training. All files were in order.

Administrator’s Certificate is valid until 04/06/2026.

During today’s inspection, the LPA conducted interviews with two (2) staff and one (1) resident. No concerns were noted.

Report Continued on LIC 809C...

MEDICATIONS: Medications review began at approximately 11:00 a.m. Medications are centrally stored in a locked cabinet by the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications were properly documented on the Centrally Stored Medication and Destruction Record (CSMDR). The Medications appear to be given as prescribed at the time of the visit.

Exit interview conducted. A copy of the report was provided.