Ark Care Home

Type of visit: Required - 1 Year

On 6/01/2026 at approximately 09:40 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the Administrator, Richard Mandac and stated the reason for their visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 12:00 PM and the following was noted: The facility is a single-story building with five (5) bedrooms and two (2) bathrooms currently occupying four (4) residents. There is a designated staff room and bathroom. The facility has an approved fire clearance for six (6) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver for two (2). Common areas: The living rooms and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 71°F. LPA observed a fire extinguisher to be located in the kitchen and dated 05/22/2026. LPA observed required postings such as See/Say Something and Personal Rights to be located alongside the hallway leading towards the bedrooms. A fireplace was observed to be covered and inaccessible to residents. A working telephone was observed. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked in the hallway closet. Kitchen appliances were observed to be working and in proper condition. (continue to LIC 809-C) Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. LPA observed appropriate auditory signals in each room working and in proper condition. Hallways/passageways are lighted appropriately Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 112.5 °F. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Garage: The garage can be accessed from inside of the facility and was observed to be kept locked. LPA observed the garage to be used for storage purposes. An additional freezer used to store additional food was observed. Laundry Room: The laundry room is located near the garage. The laundry appliances were observed to be working and in proper condition. Extra linens/covers were observed stored in the laundry cabinets. Staff Room: LPA observed staff room locked and inaccessible to residents. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water located at the facility. Medications: The medications along with staff and residents’ files were observed to be kept in a locked storage closet located within the hallway’s passageway. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and First Aid manual. Smoke detectors and carbon monoxide observed to be working properly and were tested. The Last Fire Drill was conducted on 3/06/2026. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of two (2) staff records. Staff records appeared to be complete and updated. There were no immediate health and safety hazards observed during the day of inspection. Exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 1, 2026

Type of visit: Required - 1 Year

On 4/17/2025 at approximately 10:00 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. Facility Designee Richard Mandac arrived shortly after to assist with today’s visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 11:00 AM and the following was noted: The facility is a single-story building with five (5) bedrooms and two (2) bathrooms currently occupying three (3) residents. There is a designated staff room and bathroom. The facility has an approved fire clearance for six (6) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver for two (2). Sign in sheet, hand sanitizer, gloves and masks are available upon entrance. Common areas: The living rooms and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 71°F. LPA observed a fire extinguisher to be located in the kitchen and dated 05/16/24. LPA observed required postings such as See/Say Something, Facility License, and Personal Rights alongside the hallway leading towards the bedrooms. A fireplace was observed to be covered and inaccessible to residents. A working telephone was observed. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. LPA observed an additional freezer used to store extra food located inside the garage. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked in the hallway closet. Kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C) Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. LPA observed appropriate auditory signals in each room working and in proper condition. Hallways/passageways are lighted appropriately. Extra linens/covers were observed stored in multiple cabinets located in the laundry area. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 106.7 °F. Garage: The garage can be accessed from inside of the facility and was observed to be kept locked. LPA observed cleaning solutions, toxins, and an extra freezer for food all stored within the garage and inaccessible to residents. Laundry Room: The laundry room is located near the garage. The laundry appliances were observed to be working and in proper condition. Staff Room: LPA observed staff room locked and inaccessible to residents. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water located at the facility. Medications: The medications were observed stored in a locked closet located with the hallway’s passageway. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer, and First Aid manual. Smoke detectors and carbon monoxide observed to be working properly and were tested. The Last Fire Drill was conducted on 3/01/2025. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. There were no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Facility Designee.the state’s words, verbatim · CDSS document, Apr 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met with Administrator Richard Mandac for a one (1) year required visit for this facility. Purpose of the visit was stated. There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan. Signs of Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. A tour of the physical plant was conducted with Mr. Mandac at 9:123 AM. The facility has five (5) bedrooms and two (2) bathrooms currently occupying three (3) residents. One (1) bedroom and one (1) bathroom is designated for staff use only. The facility is fire cleared for six (6) non-ambulatory residents, one of which maybe bedridden. Hospice waiver for two (2) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 76°F. Dual smoke/carbon monoxide detector is hardwired, tested and observed to be operational. There was a fire extinguisher located in the bedroom hallway. Fire extinguisher was observed to be full and last inspected on 05/16/24. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C) (continued from LIC 809) The garage is attached to the home and also being used as storage for frozen and emergency food and old equipment. The garage is observed to be locked and inaccessible to residents. Laundry room is located along the bedroom hallway going to the garage. Laundry detergents, cleaning solutions and other chemicals and toxins are locked and secured in the garage. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Dishwashing liquids and other cleaning supplies were stored in the garage. All sharps and knives were also observed to be locked in the medication cabinet. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit to non-private rooms. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Room: Staff room is observed to be locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at 111.2.°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications: LPA observed medication in the medication cabinet located in the bedroom hallway to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There is a complete first aid kit located in the bedroom hallway. Client records: Client records are reviewed and appeared to be complete and updated. Staff records: LPA also conducted a complete file review of staff records. Staff record appeared to be complete and updated. Disaster drill was last conducted on 07/01/24. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Jul 13, 2024