Carroll Manor

Type of visit: Required - 1 Year

On 9/16/2025 at approximately 09:45 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. The Administrator, Monina Miller 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 12:00 PM and the following was noted: The facility is a single-story building with five (5) bedrooms and three (3) bathrooms. The facility is located a part of a two (2) acre lot with a total of three (3) buildings. The main house for residential use was observed to be within the west wing which was observed to be located behind the main building. The facility is currently occupying five (5) residents. There is no designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for four (4). Common areas: The living room 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 77°F. LPA observed a fire extinguisher to be located alongside the hallway’s passageway and dated 04/16/2025. LPA observed required postings such as Long-Term Care Ombudsman, See/Say Something, and Personal Rights to be located throughout the common areas. A working telephone was observed. Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. (continued on LIC 809-C) Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. The main building was observed to contain the following: LPA observed the main building to be equipped with laundry room, kitchen, staff office, common area and a variety of vacant rooms. LPA observed the vacant rooms to be used for storage purposes such as clothing and liens. Kitchen: The kitchen was observed to be located in the main building separate from the residential housing. LPA observed the kitchen 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 underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. Laundry Room: The laundry appliances were observed to located within the main building. LPA observed cleaning solutions and toxins stored appropriately within the laundry room and inaccessible to residents. The laundry appliances were observed to be working and in proper condition. Garage: LPA observed there to be no garage within the premises. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. LPA observed there to be a three (3) locked sheds and one (1) locked storage unit, all inaccessible to 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 locked in the staff office. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer and First-Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. (continued on LIC 809-C) 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 hazards observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 16, 2025

The state marks this report as 11 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 Analyst (LPA) Gary Tan, met with Administrator Monina Miller for a One (1) year required visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 9:31 AM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted indoors.. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the front yard. The facility has sufficient stock of PPE in the storage room. The facility has five (5) bedrooms and three (3) bathrooms currently occupying five (6) residents. One (1) bedroom and one (1) bathroom is designated for staff use. The facility is licensed to care for six (6) non-ambulatory resident and hospice waiver for four (4) 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. The smoke detectors were last tested on 09/24/24. There is a fire extinguisher located in the bedroom hallway and was observed to be full and last serviced on 04//22/24. The facility is equipped with sprinkler and fire pull system and last inspected on 09/24/24. The backyard of the facility was wide open and the building itself is part of a two (2) acre lot with multiple buildings. There is an outdoor furniture on the lot before the gate of this house, with a covered shaded area for clients. There is no body of water in the facility. There are two (2) tool shed being used as storage for decors and equipment. The sheds are observed to be locked during visit. (continued on LIC 9099-C) (continued from LIC 809) There is no garage at this building. There is a big parking lot upon entrance of the main gate. Food Service/Kitchen is located in the former main building adjacent to current building. It is sufficiently stocked with two (2) days perishable and seven (7) days of non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. The kitchen is inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Rooms: There is no staff room at this building. 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 111.8°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications: LPA observed medication storage is located also in the former main building. Medications are listed on the centrally stored medication and destruction record. There is a complete first aid kit located in the medication cabinet. Client records: Client records are reviewed. all residents' file appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff files appeared to be complete and updated. Disaster drill was last conducted on 09/12/24 . 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, Oct 12, 2024