Routine inspection·September 4, 2025

On 09/04/2025 at 10:37AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced 1-Year Required inspection. LPA met with Caregiver, Ana Morales, Caregiver, explained purpose of visit. Rahel Mengesha, House Manager, arrived at 10:48AM. LPA explained the purpose of the visit. Facility has census of 5. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with House Manager including but not limited to bedrooms, bathrooms, kitchen, common area and back yard. The facility consists of six (6) bedrooms and three (3) bathrooms. LPA did not observe any bodies of water. A comfortable temperature is maintained at 78 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 109.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and nonskid mats. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 08/19/2025. Emergency Disaster Plan was last updated on 07/17/2025. First aid kit was observed to be complete. Fire drill was last conducted on 09/01/2025. Continued LIC809C. Continued from LIC809. LPA reviewed all five (5) resident records and four (4) staff records, and they were current and complete. LPA also reviewed a sample of medications during visit. LPA requested updated copies of the following documents to be submitted to CCLD by 09/11/2025 . LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Updated Facility Sketch Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.