Facility Evaluation Report

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 6/23/26 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator (newly designated) arrived to assist.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. The home is very clean and residents stated they are happy with care. Obstructed walkways and exits found, first aid kit is lacking supplies, medication procedures, emergency drills not conducted

LPA reviewed 3 resident files. Files are complete and well organized. LIC 625s need signatures. Bedridden resident present without fire clearance

LPA reviewed 0 staff files. Files are complete. Staff have not been associated, staff files not present.

As a result of this inspection, the following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care

Exit interview conducted with licensee and copy of report )and appeal rights) left at the facility .