Routine inspection·August 4, 2025

At 09:00 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced annual visit. LPA met with staff, Hasmik Mandlyan,and the staff contacted the Administrator. LPA explained the reason for the visit. The Administrator arrived at 9:30 AM. The physical plant tour was conducted and LPA observed the following: The facility is a single story building with four (4) bedrooms, two (2) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (6) nonambulatiory residents, of which one (1) may be bedridden in Bedroom # one (1). The facility serves residents with dementia. Approved hospice waivers for six (6). The facility uses surveillance cameras on the interior and exterior. Kitchen: At approximately, 9:35 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen cabinet. A fully charged fire extinguisher hung near the kitchen purchased on 03/01/2025. Laundry Room : At 9:40 AM, LPA observed that the cleaning solutions were locked in the laundry room, located next to the kitchen. A washer and dryer in good condition and LPA observed both were running washing and drying cloths. Medications: At approximately, 9:42 AM LPA observed medications are centrally stored and were locked near the dining room cabinet. Bedrooms: The facility has four (4) bedrooms. Two (2) are private and two (2) are shared. All bedrooms contained a nightstand, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bedroom four (4) is vacant. Continue on LIC809-C Bathrooms: The facility has two (2) bathrooms. One of the bathrooms is designated for staff and the other for residents. The bathroom designated for residents contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight-fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 9:40 AM, hot water temperature measured at 118.3°F. A closet in the hallway contained a sufficient supply of linens. Common Areas : The facility maintains a comfortable temperature at 78°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Outside areas: At approximately, 9:50 AM, LPA toured the outside area of the facility. LPA observed a covered patio area outside with furniture in good repair. The emergency exit was unlocked with an inward facing latch. Emergency exit paths were free from debris. The garage is attached to the home without an excess from the home and is kept locked inaccessible to residents. Smoke detectors/carbon monoxide . At 9:55 AM, LPA tested the dual-function smoke and carbon monoxide detector to be operational. Two (2) out of two (2) detectors were functioned during the test, and an additional verbal alert sounded. Between 10:15 AM to 11:45 AM, LPA reviewed records of six (6) residents and two (2) staff. Residents and staff records were updated and completed. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency issued. Exit interview conducted and copy of this report signed and delivered.