Routine inspection·April 30, 2026

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility to conduct an unannounced required annual visit. LPA was greeted by the Administrator. The Licensee, Nino Gelashvili and Administrator Gohar Ambartsumyan arrived shortly thereafter. LPA Urena explained the reason for the visit. The LPA and the Administrator 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. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. Cameras were observed at the time of the visit. Smoke detector and carbon monoxide were tested and were operational at the time of the visit. The fire extinguisher was fully charged and last purchased on 10/15/2025. The licensee activated them at the time of the visit. The LPA observed required postings throughout the common space. KITCHEN: Knives are stored in a locked drawer next to the stove. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Cleaning supplies were observed under the kitchen sink locked and inaccessible to residents in care. Hot water in the kitchen sink faucet measured at 115.8 degrees Fahrenheit (F). The laundry room is located next to the kitchen area. The side door leading to the hallway was observed to be unlocked at the time of the visit. Continues on LIC 809C... BEDROOMS: Had appropriate furnishings, and sufficient lighting. There are three residents’ bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are three designated client rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. RESTROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured within the regulations. The hot water temperature was measured at 116.2 degrees Fahrenheit. OUTDOORS: There were no bodies of water noted. LPA observed a sufficient amount of space for activities. There was a detached garage located on site. LPA observed garage to store extra furniture and medical supplies at this time. RECORDS: Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, 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 annual training. All files were in order. MEDICATIONS: Medications are centrally stored and locked in a cabinet in the laundry room area. medications are labeled and checked for expiration dates. The medications are documented properly on the centrally stored medications and destruction record. No errors observed during the medication review. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability of Insurance _ Emergency Drill Logs - Emergency Plan No citations were issued. Exit interview. A copy of the report was issued.