Routine inspection·March 27, 2026

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:42AM. LPA met with staff and Administrator Mariam “Maya” Kevliyan. Reason for the visit was explained. Entrance interview conducted. Beginning at 10:44AM, LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards. The following was observed: KITCHEN: LPA 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. Fire extinguishers were fully charged and last serviced 03/27/2026 during the visit . LAUNDRY/STORAGE ROOM: Washer, dryer and laundry supplies were observed inside the locked storage room by the kitchen inaccessible to residents. Cleaning solutions, emergency food and water, first aid kits, and additional incontinent care supplies were observed in the storage area. BEDROOMS: There are four (4) bedrooms total of which two (2) are for single resident-use and two (2) are for shared resident-use. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There is a staff room on the premises. RESTROOMS: There are two (2) restrooms of which one (1) is attached to Bedroom #1 and one (1) is in the hallway. Restrooms were clean, sanitary, and in operating condition with grab bars and slip-resistant surfaces. Hot water temperatures were measured in restrooms and were between 106.3-108.3 degrees F, which is within the required range. Continued on LIC-809-C. COMMON AREAS: LPA observed common area to be clean and properly furnished. At 11:19AM, 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 which were repaired to be operational during the visit. LPA observed required postings throughout the common spaces. OUTDOOR SPACE: LPA 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. MEDICATION REVIEW: At 11:22AM, LPA reviewed medications for two (2) residents. Medications are centrally stored in a locked filing cabinet near the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. LPA observed medications missing start dates on the centrally stored medications and destruction record. Administrator completed the missing start dates during the visit. RECORD REVIEWS : Beginning at 12:04PM, LPA reviewed six (6) out of six (6) resident files and 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. During the visit, LPA obtained copies of valid liability insurance, LIC 500, and resident roster. 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 drill was last conducted on 08/15/2025. Administrator completed the drill for the current quarter during the visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.