The facility has one large, assisted living building with 3 wings and 24 rooms. LPA toured the dining room, kitchen, sunshine room, sunroom, laundry room, and 5 resident rooms.

Physical Plant & Environment Safety: LPA was authorized to enter and inspect facility. LPA toured resident rooms and observed that rooms were tidy. The lighting and lamps are sufficient for the use of the facility and for resident comfort and safety. Toilet, hand washing and bathing facilities are operational and secure grab bars are present. Most rooms have their own private restroom, and 4 rooms share a restroom. All residents and public bathrooms observed were sufficiently stocked with soap and paper towels. The showers have slip-resistant mats, and the newer build has slip resistant flooring. The pathways are clear of any obstructions. Disinfectant and cleaning solutions are inaccessible to residents in care and are stored in the locked laundry room and a locked hall closet. The facility has sufficient space inside and outside for activities and visiting. The facility has a fenced yard for client use with plenty of shade. The facility has telephone and internet service for residents’ use. The fire extinguisher was last charged and inspected on 9/9/25. The facility has a fire sprinkler system that was last inspected in August of 2025. Each resident room located in the North and South wings of the facility have a carbon monoxide detector which is tested quarterly, LPA tested 3 carbon monoxide alarms.

Continued on 909-C

• 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.

Staffing, Personnel Records & Training: The facility currently employs 24 staff and 1 administrator. LPA reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid/CPR. All files were complete. Administrator’s Certificate expires on 7/19/27. The facility keeps confidential files for each staff member. Staff have annual training completed for various subjects/topics and hours 2025.

Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed five (5) resident files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, and current plan of care. All files were complete.

Food Service: The facility has 2-day perishables and 7-day non-perishables to meet the food service requirements. Knives are stored in a locked drawer in the kitchen. Kitchen appliances were in operable condition. The freezer is kept at 0 degrees, and the refrigeration is kept at 40 degrees or lower. Cleaning solutions and equipment are stored separately from food supplies.

Incidental Medical Services: Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. The facility uses the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed a sampling of residents’ medications, no labels were altered, no medications were expired, and all medications were kept in their original containers.

Disaster Preparedness: The current emergency disaster forms are located in a binder at med tech desk. The facility conducts quarterly disaster drill/training. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency.

Residents with Special Health Needs: The facility accepts dementia residents in care. The facility does not have delayed egress, and does not lock residents into facility grounds.

Exit interview conducted and copy of report printed for Administrator.