Routine inspection·September 14, 2025

Licensing Program Analyst (LPA) Jose Tan, met with Administrator Rima Abelian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 12:22 PM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a designated visitors' area at the backyard. The facility has a total of four (4) bedrooms and three (3) bathrooms. One (1) of the bathroom is designated for staff use only. The facility is fire cleared for six (6) non ambulatory residents, one (1) of which maybe bedridden on Room #3. Hospice Waiver for two (2) residents. KITCHEN: The facility has a Kitchen that is equipped with a refrigerator, microwave, stove, dishwasher and sink. There was an adequate supply of perishable and nonperishable food. Knives were observed locked in a kitchen drawer. Cleaning supplies and other toxins are stored in the cabinet in the bedroom hallway which was locked during visit. BEDROOMS: There are three (3) shared bedrooms for clients' use and two (2) bedroom for designated for staff use. The residents' bedrooms are furnished with beds, night stand, chairs, dressers, bedding and linen and have sufficient lighting and storage. (continued on LIC 809-C) (continued from LIC 809) BATHROOMS: The facility has three(3) bathrooms, two (2) are designated for staff use only. The bathroom was observed to have the proper fixtures, grab bars, and non-skid mats. The hot water temperature was measured at 105.6°F. LAUNDRY ROOM: The laundry room is located adjacent to the kitchen. Laundry detergents and other cleaning agents were locked in a cabinet in the laundry area. The cleaning supply cabinet was observed to be locked during visit. COMMON AREAS: These included the living room and the dining area. Living room was furnished with chairs and side tables. The living room area was furnished with a television. There was no visible immediate hazards. Dual smoke/carbon monoxide alarms were tested and observed to be operable. Fire extinguisher was last serviced on 01/22/25 and located in the dining room area. The facility is equipped with closed circuit television system in the outside surroundings and common areas only. MEDICATIONS: The medication cabinet is located in the bedroom hallway adjacent to the living room and observed to be locked during visit. A complete first aid kit is located in the kitchen. Resident Records: All residents record were reviewed and observed to be complete and updated. Staff records were also reviewed and observed to be complete and updated. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The front yard of the facility has a covered patio and outdoor furniture to accommodate the residents. The Garage is currently being used as frozen foods, PPE and other supplies storage. There are two (2) tool shed on the backyard separated by a 5' gate and inaccessible to residents. There is a drive way in side of the facility which could park three (3) cars at a time. There is no body of water in the facility. Disaster drill was last conducted on 07/01/25 . Required posting observed in facility (complaint hot line poster). Exit interview conducted. Copy of this report issued.