Routine inspection·April 24, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 12:10PM. The LPA was greeted by staff, informed them of the reason for the visit, and staff proceeded to notify the Licensee. Licensee/Administrator Sophia Labendze arrived at 12:50PM. Entrance interview conducted. Beginning at 12:53PM, the LPA and the Licensee 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: The LPA observed the facility kitchen at 12:55PM. Knives are stored inaccessible in a locked drawer near the sink. Cleaning supplies are stored inaccessible and locked under the sink. Kitchen appliances were clean and in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency food and water that is located in the hallway pantry and remains locked. Hot water was tested and measured at 108 degrees F. Food in the refrigerator was observed to be properly stored with labels and dates. LPA Huynh noted required signage and postings in the Kitchen entryway. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which was observed to be screened and inaccessible. The facility maintained a comfortable temperature throughout the visit. Smoke and carbon monoxide detectors were tested at 1:30PM and were operational at the time of the visit. Two fire extinguishers were observed throughout the facility and was purchased on 04/12/2025. BEDROOMS/RESTROOMS: There are seven total bedrooms; six private resident bedrooms and one staff bedroom. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are stored in the hallway cabinets. There are five total bathrooms in the facility; two is designated as a shared resident/common area restroom, one shared jack and jill resident restroom, one private resident restroom, and one private staff restroom. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 105.6 degrees F and 116.2 degrees F. OUTDOOR AREA: The backyard has two patio areas equipped with furniture for resident and visitor use. There is one driveway gate used for emergency exit which has a self-latching mechanism and remains locked with the key accessible nearby. No bodies of water noted, and exits are free of obstructions. The LPA observed a detached garage behind the facility which contained general storage, laundry machines, and Personal Protection Equipment. RECORDS: Record review began at 1:32PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. 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. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 2:05PM. Medications are centrally stored and kept inaccessible in the kitchen. Medications were observed for two residents. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL /EMERGENCY DISASTER PLAN: During today's visit, 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 03/21/2025. No deficiencies cited. Exit interview conducted. A copy of today's report was provided.