Routine inspection·May 29, 2025

On 5/29/2025 at approximately 10:00 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. The Administrator, Romik Rostomyan arrived shortly after to assist with today’s visit. LPA asked for the census, Staff/Resident Roster, and Liability Insurance. LPA conducted a physical plant tour at approximately 12:00 PM and the following was noted: The facility is a single-story building with three (3) bedrooms, two (2) bathrooms and one separate (1) shower. The facility is currently occupying four (4) residents. There is no designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents of which one (1) may be bedridden. Hospice waiver approved for two (2). Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 75°F. LPA observed a fire extinguisher to be located in the kitchen and dated 02/29/2024. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights alongside the entrance leading towards the kitchen. A working telephone was observed. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked in an outside storage compartment. Kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C) Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed stored in laundry area located aside the kitchen. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured within regulations at 119.0 °F. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Laundry Room: The laundry room was observed to be located near the kitchen. LPA observed cleaning solutions and toxins stored outside in a locked storage compartment. The laundry appliances were observed to be working and in proper condition. Garage: LPA observed there to be no garage located within the premises. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water located at the facility. Medications: The medications were observed stored in a locked cabinets located in the kitchen. LPA observed staff and resident files to be kept locked in storage cabinet located in the staff/reception desk area. First-aid kit observed to be equipped with but not limited to bandages, scissors, digital thermometer, tweezer and First-Aid Manuel. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff record appeared to be complete and updated. There were no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to the Administrator.