Routine inspection·December 17, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:55AM. LPA was greeted at the door by staff and the reason for the visit was explained. Licensee, Tom Stiles arrived at 11:30AM. Entrance interview conducted. At 11AM, the LPA along with staff, 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. KITCHEN/LAUNDRY: The LPA inspected the kitchen/food service area at 11AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for expiration dates; food labels had expiration date clearly marked. Knives and sharps are stored locked and inaccessible to residents in care. LPA observed the laundry unit by the kitchen. Detergents and solutions were locked inaccessible. BEDROOMS: There are five (5) resident bedrooms of which four (4) are for private-use and one (1) is for shared-use. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There is a staff room on premises. RESTROOMS: There are three (3) restrooms of which one (1) is for private-use, and two (2) are for shared-use. Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. Hot water temperatures were measured in restrooms and were between 105.3-109.8 degrees F, which is within the required range. Report Continued on LIC 809-C. COMMON AREAS: At the time of the visit, living room and dining room furniture were observed to be in good condition. There is one (1) fireplace which was observed adequately screened. The facility maintained a comfortable temperature. The hardwired smoke detector(s) and carbon monoxide detector were tested at 11:45AM and all were operational at the time of the visit. The fire extinguisher was fully charged and last purchased on 12/11/2025. The LPA observed required postings throughout the common space. All auditory exit devices in common areas were functional and operating at the time of the visit. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate which was observed to self-latch. No bodies of water and obstructions noted. MEDICATION REVIEW: At 11:50AM, LPA reviewed medications for two (2) residents. Medications are centrally stored and locked in cabinet in the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to 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. RECORD REVIEW: Beginning at 12:30PM, LPA reviewed five (5) out of five (5) resident files and four (4) out of four (4) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training and fingerprint clearance. All resident and personnel files were in order. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the 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 drills are conducted quarterly as required. INTERVIEWS: During today’s visit, LPA interviewed four (4) residents and two (2) staff. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.