Routine inspection·September 11, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 11:34AM. LPA met with Administrator Jennifer Fernandez. Entrance interview conducted. Beginning at 11:37AM, the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: LPA inspected the kitchen at 11:37AM. Knives and sharps are stored in a locked drawer. At 11:38AM, LPA observed cleaning supplies and chemicals accessible under the sink. Administrator moved chemicals to the locked garage. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food and an emergency water supply. At 11:42AM, LPA observed an opened bottle of maple syrup and soy sauce stored in the pantry, however, bottles state to refrigerate after opening. Administrator discarded the items. BEDROOMS : The facility consists of seven (7) total bedrooms; six (6) are designated for single-resident use and one (1) is designated for staff use and is kept locked. Bedrooms #1, #3, #4, #5, and #6 have exits to the exterior. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, closet space, and sufficient lighting. BATHROOMS : There are three (3) full bathrooms; one (1) in the main hallway and two (2) Jack and Jill's (between room #4 and staff room, and room #5 and #6). LPA observed bathrooms to be clean, sanitary and in operating condition with grab bars and slip-resistant surfaces. Hot water temperatures were measured in bathrooms and were between 106.0-106.7 degrees F. Report Continued on LIC 809-C. COMMON AREAS : This includes the living room, family room, and dining room. LPA observed common areas to be clean and properly furnished at the time of the visit. The facility smoke alarm system is hard wired. The smoke detectors and carbon monoxide detector in the hallway were tested at 11:56AM; all were operable at the time of the visit. At 11:58AM, LPA observed the fire extinguisher by the kitchen last serviced over a year ago on 08/28/2024. Staff purchased and installed a new fire extinguisher during the visit on 09/11/2025. Emergency exiting plans/sketch, license, personal rights, and other required postings are posted on the entry way wall. LPA observed auditory exit alarms by all exit doors in the common areas and bedrooms. Staff replaced exit alarm batteries during the visit and alarms were functional. OUTDOOR SPACE: The backyard has a covered patio area with furniture including a table and chairs. There were no bodies of water on the premises. One (1) pathway is used as an emergency exit which was free of obstruction and equipped with a self-latching gate. LPA observed the door stopper by the exit gate preventing the door from closing; Administrator stated the door stopper will be repaired. GARAGE/LAUNDRY: At 12:00PM, LPA observed the locked garage. The garage can be accessed from the side of the property and from the dining area by the kitchen. The garage contains additional supplies, a washer and dryer, detergents, and an additional refrigerator/freezer. MEDICATION REVIEW: Medications are centrally stored and locked in a cabinet in the dining room. LPA began medication review at 12:05PM and medications for two (2) residents were observed. All medications were labeled and maintained in compliance with label instructions, and state and federal law. RECORD REVIEW: LPA began record review at 12:38PM. LPA reviewed three (3) out of three (3 ) resident files and four (4) personnel files for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Resident and personnel files were complete and had no missing documents. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly, with the last drill conducted on 09/11/2025 during the visit. During today's visit, LPA obtained a copy of the facility's liability insurance. No deficiencies cited at this time. Exit interview conducted and a copy of the report was provided.