Homelife Senior Living 8

Type of visit: Required - 1 Year

The purpose of this amendment is to change the Visit Type. Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:55 a.m. Upon arrival, LPA Mosley was greeted by staff and the Administrator. LPA met with Administrator, Dvora "Debbie" Leventer and the reason for the visit was explained. Entrance interview. The LPA and 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 facility is a single-story home located in a residential neighborhood with three (3) other structures / facilities on the same property which are all licensed individually as part of the same ownership. COMMON AREAS: This includes the TV room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 11:20 a.m., hardwire combination of smoke and carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 11/03/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. Activities were observed in the common areas. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility however Administrator stated that all are inactive and will remain inactive. INTERVIEWS: Starting at 10 a.m. and throughout the visit one (1) staff and two (2) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. LPA observed residents participating in the facilities music program. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff room is kept locked at all times and observed to be occupied by staff. All six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are seven (7) total restrooms. One (1) is designated as a staff / guest restroom, six (6) are designated as a private resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 109.5-115.5 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. LAUNDRY ROOM: LPA observed the locked laundry room adjacent to the main hallway. Laundry room has a washer and dryer and locked cleaning supplies. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.5 degrees Fahrenheit. Cleaning supplies and other chemicals are kept in the locked laundry room and inaccessible to residents in care. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located directly outside the sliding doors from the kitchen. There is a common recreational area with an additional covered patio area with furniture and a putting green for resident use. There were no bodies of water noted at the time of the visit. There is no front yard gate or driveway gate for the house individually, however the entire property is fenced. The garage is attached to the property. On 07/20/2026, the Licensee Representative submitted a notice, along with city permits, informing the Department that the facility will undergo construction in the garage to convert it into an additional dwelling unit (ADU). Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2...The Administrator informed LPA that the construction work will not impact any resident common areas, bedrooms, bathrooms, or other interior or exterior spaces currently used by residents. Resident evacuation routes, room status, and fire clearance requirements will remain unaffected. The ADU will not be used by residents or have resident access and will be utilized by staff only. Administrator stated that the construction is complete with phase one (1) and is awaiting city inspection to move to phase two (2). INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. The last emergency disaster drill took place on 06/29/2026 and are conducted quarterly. The emergency disaster plan and infection control plan were updated on 01/19/2026. RECORDS: Resident Records: Six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Pre- admission appraisal, LIC627(c) Consent for Treatment form, Home Health records, Hospice records, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records five (5) 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 training. All records were in order. At the time of the visit LPA conducted a business search to ensure the Business / LLC is in good standing ; Active and in good standing. MEDICATIONS: Medication review began at approximately 1:30 p.m. Medications are centrally stored and locked in a closet in the main hallway, adjacent to the living room. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, copy of the Limited Liability insurance, and Emergency disaster plan (LIC 610E). At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator confirmed that all information is accurate. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:55 a.m. Upon arrival, LPA Mosley was greeted by staff and the Administrator. LPA met with Administrator, Dvora "Debbie" Leventer and the reason for the visit was explained. Entrance interview. The LPA and 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 facility is a single-story home located in a residential neighborhood with three (3) other structures / facilities on the same property which are all licensed individually as part of the same ownership. COMMON AREAS: This includes the TV room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 11:20 a.m., hardwire combination of smoke and carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 11/03/2025. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. Activities were observed in the common areas. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility however Administrator stated that all are inactive and will remain inactive. INTERVIEWS: Starting at 10 a.m. and throughout the visit one (1) staff and two (2) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. LPA observed residents participating in the facilities music program. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff room is kept locked at all times and observed to be occupied by staff. All six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are seven (7) total restrooms. One (1) is designated as a staff / guest restroom, six (6) are designated as a private resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 109.5-115.5 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. LAUNDRY ROOM: LPA observed the locked laundry room adjacent to the main hallway. Laundry room has a washer and dryer and locked cleaning supplies. KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 110.5 degrees Fahrenheit. Cleaning supplies and other chemicals are kept in the locked laundry room and inaccessible to residents in care. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located directly outside the sliding doors from the kitchen. There is a common recreational area with an additional covered patio area with furniture and a putting green for resident use. There were no bodies of water noted at the time of the visit. There is no front yard gate or driveway gate for the house individually, however the entire property is fenced. The garage is attached to the property. On 07/20/2026, the Licensee Representative submitted a notice, along with city permits, informing the Department that the facility will undergo construction in the garage to convert it into an additional dwelling unit (ADU). Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2...The Administrator informed LPA that the construction work will not impact any resident common areas, bedrooms, bathrooms, or other interior or exterior spaces currently used by residents. Resident evacuation routes, room status, and fire clearance requirements will remain unaffected. The ADU will not be used by residents or have resident access and will be utilized by staff only. Administrator stated that the construction is complete with phase one (1) and is awaiting city inspection to move to phase two (2). INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. The last emergency disaster drill took place on 06/29/2026 and are conducted quarterly. The emergency disaster plan and infection control plan were updated on 01/19/2026. RECORDS: Resident Records: Six (6) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Pre- admission appraisal, LIC627(c) Consent for Treatment form, Home Health records, Hospice records, PRN authorization letters, and current needs and services plan. All records were in order. Personnel Records five (5) 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 training. All records were in order. At the time of the visit LPA conducted a business search to ensure the Business / LLC is in good standing ; Active and in good standing. MEDICATIONS: Medication review began at approximately 1:30 p.m. Medications are centrally stored and locked in a closet in the main hallway, adjacent to the living room. Medications for three (3) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster, LIC 9020A Resident roster, copy of the Limited Liability insurance, and Emergency disaster plan (LIC 610E). At the time if the visit the LPA reviewed the facilities contact information on file including phone numbers, email and annual fees. Administrator confirmed that all information is accurate. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 10 a.m. Upon arrival, LPA Mosley was greeted by staff and the Administrator. LPA met with The Administrator, Dvora "Debbie" Leventer and the reason for the visit was explained. Entrance interview. The LPA and staff / 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. COMMON AREAS: This includes the TV room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 12:20 p.m., hardwire combination of smoke / carbon monoxide detectors and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 11/07/2024. The emergency exiting plans/sketch are posted in every room. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 07/11/2025 and are conducted quarterly. Activities were observed in the common areas. There is a functioning telephone on the premises. LPA observed surveillance cameras installed in the common areas of the facility however all are inactive and will remain inactive. INTERVIEWS: Starting at 10:28 a.m. and throughout the visit one (1) staff and two (2) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... KITCHEN: The LPA inspected the kitchen/food service area at 10:26 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 115.5 degrees Fahrenheit at 10:31 a.m. Cleaning supplies and other chemicals are kept in the locked laundry room and inaccessible to residents in care. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private, single occupancy, resident rooms and one (1) staff room. The staff room is kept locked at all times and observed to be occupied by staff. All six (6) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are seven (7) total restrooms. One (1) is designated as a staff / guest restroom, six (6) are designated as a private resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 110.5-115.5 degrees Fahrenheit, all within the required range. LPA observed storage space closets in hallway containing extra clean linens and towels for resident use. LAUNDRY ROOM: LPA observed the locked laundry room adjacent to the main hallway. Laundry room has a washer and dryer and locked cleaning supplies. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located outside the front entrance. There are three (3) additional licensed facilities on the property. All four (4) facilities share a common recreation area with additional covered patio with furniture, and a putting green for resident use. There are no bodies of water noted on the premises. There is no front yard gate and the driveway gate is kept unlocked. GARAGE: The garage was observed to be locked and contain storage, a refrigerator and freezer, both containing extra food. Both were checked for proper labels and expiration dates. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... RECORDS: Record review began at approx. 10:50 a.m. Resident Records: were reviewed beginning at 11:00 a.m. Six (6) 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 records were in order. Personnel Records were reviewed beginning at 11:40 a.m. Four (4) 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 training. All records were in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the criteria standard. MEDICATIONS: Medication review began at approximately 12:50 p.m. Medications are centrally stored and locked in a closet in the main hallway adjacent to the entrance to the home. Medications for four (4) residents were reviewed. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self administered as prescribed and documented on the centrally stored medication and destruction records. No errors observed during review. DOCUMENTS: Documents obtained during the visit include: LIC 500 Facility roster, LIC 9020A Resident roster and copy of the current Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report reviewed and provided.the state’s words, verbatim · CDSS document, Sep 4, 2025

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kelly Dulek and Erica Mosley arrived at the facility unannounced at 09:05AM with the purpose of conducting a required annual visit. The LPAs initially met with facility staff. Administrator Dvora "Debbie" Leventer was contacted via telephone and arrived at approximately 09:40AM. Entrance interview conducted. Beginning at 10:39AM, the LPAs, along with 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: Fire extinguisher was observed to be fully charged and last serviced 06/03/2024. Hardwired combination smoke/carbon monoxide detectors were tested at 11:51AM and were functional at the time of the visit. BATHROOMS: There are (7) seven full bathrooms. There are (6) six private bathrooms for resident use, the full bathroom at the entrance of the home next to Room A (Staff Office) is designated for staff and guests. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature in bathrooms measured between 106.1 – 114.8 degrees Fahrenheit, which is within the required range. BEDROOMS: There are (7) seven bedrooms in the facility; the facility has (6) six private bedrooms for resident use, and (1) one room that is used as a staff office and to store files. The staff office is kept locked. All resident rooms were observed and contain appropriate furnishings, linens, and adequate lighting. LAUNDRY: The laundry area is in a locked laundry room located in the main hallway. Laundry detergent and cleaning supplies are stored inaccessible in the locked laundry room. Report Continued on LIC 809-C Continued from LIC 809 (p.1) GARAGE: The garage was observed to be locked and contain storage, a refrigerator and freezer, both containing extra food. COMMON AREA: The common areas were appropriately furnished and the lighting was adequate. There is a television and other entertainment equipment in the living room area. There is a functioning telephone on the premises. All required postings were observed on the entrance area wall. Emergency exiting plans/sketch are posted. Auditory alarms were observed on all exit doors. Various exit door alarms were tested and were functional at the time of the visit. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer next to the stove. The supply of perishable and nonperishable food is adequate, as well as emergency food and water supply. Appliances in the kitchen were clean and appeared functional. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located outside the front entrance. There are 3 (three) additional licensed facilities on the property. All 4 (four) facilities share a common recreation area with additional covered patio with furniture, a putting green, and bocce ball area for resident use. There are no bodies of water noted on the premises. There is no front yard gate and the driveway gate is kept unlocked. RESIDENT & STAFF RECORDS: Beginning at 11:23AM (resident) and 12:10PM (staff), LPAs reviewed resident and staff files for but not limited to: physician's report, Admission Agreement, personal rights, staff health screening, TB test, background clearance, and training records. All 5 (five) of 5 (five) resident files reviewed and 5 (five) of 5 (five) staff files reviewed were observed to be complete and in compliance with Title 22 regulation. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPAs reviewed the facility's infection control plan and emergency disaster plan. The facility's policies as it pertains to infection control are adequate. The facility's emergency disaster plan was observed to be complete and updated annually, as required. Emergency disaster drills are conducted quarterly, with the last drill conducted on 07/21/2024. Report Continued on LIC 809-C (p.3) Continued from LIC 809-C (p.2) MEDICATIONS: Medications are stored in a medication closet located in the main hallway and is kept locked with a self-closing digital lock. The first aid supplies were complete, including a first aid manual. Medications were observed for 3 (three) residents. All 3 (three) of 3 (three) medications reviewed were stored and documented in compliance with regulation. INTERVIEWS: Throughout today's visit, LPAs interviewed 4 (four) staff and 2 (two) residents. No concerns were noted. During today's visit, LPAs obtained a copy of the following documents: liability insurance Personnel Report (LIC 500) No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Aug 16, 2024