Routine inspection·March 11, 2025

Licensing Program Analysts (LPAs) Emily Peraldi and Quoc Huynh arrived at the facility unannounced to conduct a required annual visit. At 10:05 a.m., the LPAs met with staff and explained the reason for visit. At 10:15 a.m., the Administrator, Mariam Kevliyan arrived at the facility. At 10:20 a.m., the LPAs along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. KITCHEN: The LPAs observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:35 a.m., hot water measured at 106.0-degree Fahrenheit. Medications are located in a locked filing cabinet near the kitchen. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms and two (2) bathrooms. The LPAs observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:21 a.m., hot water measured at 106.9-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: The LPAs observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. There are no bodies of water on the premises. Continued on LIC-809-C. LAUNDRY/STORAGE ROOM: Washer, dryer and laundry supplies were observed inside the locked storage room inaccessible to residents. Cleaning solutions, first aid kits and additional incontinent care supplies were observed in the storage area. COMMON AREAS: The LPAs observed common area to be relatively clean and properly furnished. The LPAs observed the fire extinguisher to be fully charged and last serviced on 12/27/2024. At 10:25 a.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. RECORD REVIEWS: Between 10:30 a.m. and 11:28 a.m., the LPAs conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid. The Administrator stated that required annual training is going to be completed this month. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. The LPAs also reviewed the facility's emergency disaster plan, which was observed to be complete and updated. Starting at 12:57 p.m., the LPAs conducted a review of medication and medication documentation with Administrator for three (3) out of five (5) residents. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.