Beginning at 10:08 AM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

COMMON AREAS: This included the activity room, hallway, and dining room areas. LPA observed the activity room to be clean and properly furnished at the time of the visit. The common activity room contained a television and activities for resident use. The dining room contained adequate seating for resident use. Cameras were observed in the common areas and hallways throughout the facility. LPA observed the hallway to contain a dry food storage closet, the locked medication room, the Administrator’s office, a common resident bathroom, and a shower room. Additionally the hallway was observed to contain the activity calendar, emergency exit sketches, and other required postings. The LPA observed fire extinguishers throughout the facility to be fully charged and last serviced on 02/18/2026. Smoke detectors and carbon monoxide detectors were last tested on 07/26/2026 and were functional at the time of the test.

BEDROOMS: There are twenty-seven (27) bedrooms in the facility; all are designated for resident use. LPA and facility Administrator toured ten (10) resident rooms. All viewed resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

CONTINUED ON LIC 809C.

INTERVIEWS: LPA interviewed three (3) staff and three (3) residents. All residents stated that staff treat them well and are attentive to their needs. Residents interviewed did not have concerns with the quality of care they received at the facility. All staff interviewed were knowledgeable on their roles and responsibilities, the residents’ rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse.

During today’s visit LPA obtained a copy of the facility’s updated emergency disaster plan, current liability insurance, employee roster, and resident roster.

No deficiencies were observed during today’s inspection. Exit interview conducted and a copy of the report was provided.

• 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.

KITCHEN: The LPA observed the kitchen area to be clean and inaccessible to clients in care. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days’ perishable and seven (7) days non-perishable food. The facility had an adequate supply of emergency food and water.

OUTDOOR SPACE: LPA observed the outdoor area to have sufficient space for outdoor activities. The patio was observed to contain adequate patio furniture including shaded tables and chairs for residents’ use. The patio of the facility contained a small water fountain. LPA observed a locked laundry room and a locked storage room. The facility had an emergency exit gate, LPA observed clear passageways for emergency exit use.

RECORD REVIEW: Record review began at 10:53 AM. 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, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed. All resident files reviewed contained all required documentation and signatures. No deficiencies were observed during record review.

MEDICATION REVIEW: Medication review began at approximately 12:20 PM. Medications are stored centrally and securely in the medication room. Medications for five (5) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet. No deficiencies were observed during medication review.

CONTINUED ON LIC 809C.