The facility was last visited on 08/19/25 for an annual visit. It is a single story building with five (05) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06).

At the main entrance, LPA observed a screening station for infectious diseases which contained hand sanitizer, a digital thermometer, masks, and a visitor sign-in sheet. Postings were observed at the front for the infection control plan, emergency disaster plan, personal rights, house rules, rights of resident councils, theft and loss policy, ombudsman contacts, confidential complaint contacts, facility sketch with emergency exit routes clearly labelled, administrator certificate, facility license, and COVID postings.

Walls, floors, windows, screens, and blinds were clean and in good repair. The living room at the front contained furniture in good repair, television, reading material, and a covered fireplace. LPA called out from the telephone at approximately 9:15 a.m. It was deemed operational. The dining room contained a piano, board games, television, and furniture in good repair. Two (02) residents were observed watching television a the dining room table. Surveillance cameras were used in common areas. A sufficient supply of linens and towels were located in the hallway closet. At approximately 9:30 a.m. LPA observed fully charged fire extinguishers in the kitchen and patio area. The kitchen extinguisher was last checked on 03/13/26 and had a tag attached. Confidential files were locked in the office area. The garage was locked and contained medications, an extra refrigerator, cleaning supplies, medications, and other resident supplies.

• 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.

The facility has five (05) private bedrooms. All bedrooms contained a lamp, a chair, nightstand, and a bed with adequate bedding. All furnishings were clean and in good condition. All hospital-style beds had wheels in the locked positions. The facility has two (02) bathrooms. One (01) bathroom is private to Bedroom #1, and one (01) is shared. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 10:20 a.m. LPA measured the water temperature in the private bathroom to be 105 degrees Fahrenheit.

LPA observed an adequate supply of perishable and non-perishable foods in the kitchen and garage. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter top. Cleaning solutions were locked below the sink. At 10:30 a.m. LPA observed the refrigerator and freezer temperatures to be 40 and -1 degrees Fahrenheit, respectively. A washing machine and dryer were located near the kitchen. Both were in working order.

LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. At approximately 10:40 a.m., smoke and carbon monoxide detectors were tested and operational. Detectors were hard-wired and operated simultaneously. Two (02) out of two (02) fire doors closed when the detectors were tested. All emergency exit paths were free from obstructions. The exit gate was unlocked. Evacuation routes were posted.

At approximately 11:15 a.m. LPA conducted a record review of resident and personnel files. All files were complete and available for audit. Facility liability insurance is valid through 07/22/27.

During today’s inspection, no immediate health or safety concerns were observed.

Exit interview conducted. Copy of report provided.