Hickorywood Care Home

Type of visit: Required - 1 Year

On 5/20/2026, Licensing Program Analyst (LPA) Mia Lankford conducted an unannounced Annual visit. LPA was granted entry by caregiver Carmelita Juliano, who was informed of the purpose of visit; Licensee David Carlson arrived to the facility shortly after. At the time of the visit there was four (4) residents present. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA conducted a tour of the facility with Licensee David Carlson. The physical plant is a one story structure that contained five (5) resident bedrooms with one (1) caregiver bedroom, and three (3) bathrooms. The facility has a dining room, kitchen, living room, garage, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There were no bodies of water located on the property. The facility has more than a two (2) day supply of perishable food and seven (7) day supply of non-perishable foods. Extra linen were observed in the closet located in the hallway. Knives and sharp items were observed in a locked cabinet in the kitchen. Resident bedrooms had the required bedding, furniture, and lighting. The smoke and carbon monoxide detectors were tested and were observed to be operable. Centrally stored medications were observed in the kitchen in a locked medication cart. There are Three (3) fully charged fire extinguishers that were observed in the facility last served 4/14/2026. The living room was observed to have board games and other activities. The facility was observed to be in a clean condition; free of dirt, insects, rodents, and pests. Cont.... Cont... Staff files were reviewed that included: ADMIN certification expires 1/1/2027, personnel records, health screenings, criminal record clearance, required training, and valid first aid/CPR certification. Resident files included: signed admission agreements, personal rights, house rules, needs and service plans, and updated physician reports. Facility sketch, LTCO, CCL complaint poster, license and emergency disaster plan is posted on a wall in the living room near the entrance. Last fire drill was on 4/30/2026. The temperature in the home was at 75 degrees Fahrenheit. Water temperature was 106 degrees. During today's visit, LPA did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee David Carlson.the state’s words, verbatim · CDSS document, May 20, 2026

Type of visit: Required - 1 Year

On 05/28/2025 Licensing Program Analyst (LPA) Debbie Palacios conducted an unannounced one (1) year required visit. LPA was granted entry by caregiver, John Hernandez Juliano, who was informed of the purpose of visit; Licensee David Carlson arrived to the facility shortly after. At the time of the visit there was four (4) residents present. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA observed the following during today's visit: LPA conducted a tour of the facility with Licensee David Carlson. The physical plant is a one story structure that contained five (5) resident bedrooms with one (1) shared bedroom, one (1) staff bedroom, and three (3) bathrooms. The facility has a dining room, kitchen, living room, garage, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There were no bodies of water located on the property. The facility has more than a two (2) day supply of perishable food and seven (7) day supply of non-perishable foods. Extra linen were observed in the closet located in the hallway. Dishes and utensils were in sufficient supply and in good repair. Knives and sharp items were observed in a locked cabinet in the kitchen. Resident bedrooms had the required bedding, furniture, and lighting. The smoke and carbon monoxide detectors were tested and were observed to be operable. Centrally stored medications were observed in a locked cabinet near the kitchen area. The outdoor patio was observed to have shaded seating to encourage outdoors socialization. Three (3) fully charged fire extinguishers were observed in the facility last served 01/29/2025. The living room was observed to have board games and other activities. The facility was observed to be in a clean condition; free of dirt, insects, rodents, and pests. Staff files reviewed include but not limited to have personnel records, health screenings, criminal record clearance, required training, and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, personal rights, house rules, needs and service plans, and updated physician reports. Facility sketch, LTCO, CCL complaint poster, license and emergency disaster plan is posted on a wall in the living room near the entrance. During today's visit, LPA did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee David Carlson.the state’s words, verbatim · CDSS document, May 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit . LPA was granted entry and met with licensee Emelinda Carlson and David Carlson, who was informed of the purpose of the visit. At the time of the visit there was two (2) staff and two (2) residents present. The facility is licensed for six (6) non-ambulatory residents. The facility has a hospice waiver for six residents. A dementia program is also on file. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards and contained outdoor furniture for residents in care. LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. Facility contained PPE equipment and cleaning supplies to do regular cleaning of the facility. Cleaning supplies and detergents were stored and inaccessible to clients. The sharp and dangerous objects were observed to be locked and inaccessible to residents. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA reviewed two (2) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid Certification. Two resident files were reviewed, and possessed all required paperwork which included Admissions Agreement, Needs and Service Plan, and Physician's Report. The listed administrator possesses a current administrator's certificate. Resident medication was centrally stored and locked in a closet located in the hallway. LPA reviewed medications prescribed to the residents and found all medication listed on the Medication Administer Record (MAR) had all required labeling and signatures found to be in place. LPA reviewed the facility's emergency and disaster plan. LPA observed all facility exits were clear from obstructions. Records review revealed last fire drill was conducted 04/01/2024 which met department requirements. LPA observed emergency supplies and first aid kit with all required items. Facility contains multiple charged fire extinguishers located throughout the facility/ No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to Licensee Carlson.the state’s words, verbatim · CDSS document, May 9, 2024