Routine inspection·April 10, 2025

Licensing Program Analyst (LPA) Abeye Duguma met with, Dolores Ayson, for a Required One (01) Year visit. LPA explained the reason for the visit. LPA spoke with the administrator, Edelwina Calica, and she designated Ayson to sign and accept the report. A tour of the physical plant was conducted at 01:30 PM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of three (03) resident bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory and a hospice waiver for one (01). The facility is currently occupying four (04) non-ambulatory residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 74°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen, observed to be fully charged and last purchased 07/10/2025. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 116.2°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.