Post-licensing visit·January 6, 2026

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced post-licensing visit to the above facility. At 11:26AM, the LPA met with the Administrator Mary Petikyan. Entrance interview conducted. Beginning at 11:48AM, the LPA and Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: Knives were stored in a locked kitchen drawer. Cleaning supplies were observed locked under the sink. The supply of nonperishable and perishable food was adequate. Food in the refrigerator and freezer were of good quality and labeled with dates. Appliances in the kitchen were clean and operational. BEDROOMS/BATHROOMS: The facility had seven (7) bedrooms: six (6) private resident rooms and one (1) staff room. Bedrooms #3, #6, and the staff room have direct exits to the outside with Bedroom #6 approved for one (1) bedridden resident. Bedroom #1 had a screened and inoperable fireplace. Bedrooms contained required furniture and had sufficient lighting with ample space for easy passage. Extra supply of linens was stored in the hallway closet. There were five (5) bathrooms: three (3) private resident bathrooms and two (2) shared common bathrooms. Each bathroom contained non-slip mats, grab bars, paper products, and soap. One (1) shared bathroom contained a laundry closet that was secured with machines in operable condition. Hot water temperature was tested and measured between 107.6 degrees F and 120.3 degrees F. Report Continued on LIC 809-C COMMON AREAS: The living room and dining room furniture were observed to be in good condition. The facility maintained a comfortable temperature throughout the visit. There was sufficient space to accommodate both indoor and outdoor activities. Nightlights were observed throughout the common areas. All required postings were posted near the entrance of the facility. OUTDOOR AREA: The exterior passageways were clean and clear of any obstructions. There were two (2) areas at the back of the house with tables and chairs where residents can sit. The outdoor space is property gated. There were no bodies of water on the premises at the present time. There was one (1) emergency exit that led to the front yard which contained a remote operated driveway gate and a self-latching door gate for everyday usage. The premises had a locked garage that was used as facility storage and contained extra food with a refrigerator and emergency food and water. RECORDS: Record review began at 12:22PM. Resident records were reviewed for, but not limited to care plans, physician’s report, admissions agreement, and consent forms. All records were in order. The LPA discussed ensuring that all resident documents are signed. The Administrator agreed and stated there was a delay with the residents’ families. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly with the last documented drill on 10/03/2025 and the next drill planned for this month. Fire extinguishers were observed throughout the facility and last purchased on 04/24/2025. Combination smoke and carbon monoxide detectors and fire doors were tested at 2:04PM and were operational. Due to unforeseen circumstances, the LPA will return at a later date to conduct the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.