Routine inspection·January 21, 2026

On 1/21/2026 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Co-Administrator / DCS Solomon Gochin, who granted access to the facility. LPA explained the reason for the visit. LPA Khurshudyan reviewed the required postings posted on the wall of dining and living room areas and requested staff and residents’ rosters for review. The inspection tool was used to complete the visit. At 10:10am LPA, with the help of the DCS/Caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with five (5) bedrooms, of which three (3) rooms designated for residents’ use. There are two (2) bathrooms, a kitchen, common areas: living and dining rooms, and an outdoor area. Facility has an approved fire clearance for six (6) Non-ambulatory residents, one (1) bedridden resident for room #1, and a Hospice waiver for three (3) residents. Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked cabinet in the laundry room. Sufficient amount of emergency supply of food / water was readily available. Food storage and preparation areas are clean and inaccessible to pests. LPA observed one (1) fire extinguishers located in the living room. The fire extinguisher was last serviced on 5/13/2025. Dish soap and other chemicals were observed to be stored inside the locked cabinet and inaccessible to residents in care. Continue on LIC809-C Bedrooms: LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. Residents have enough personal hygiene products. Common Areas: These include living and dining areas . LPA observed dining, living areas clean and clear of clutter. Furniture is generally new and in a good repair. Dining and living room furniture sits at the capacity of the facility. Walls, floors, windows, screens, and blinds were clean and in good repair. At 10:45am, LPA measured the room temperature to be 67 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found inside the facility. Facility has landline, LPA checked it was operational. Bathroom: The bathrooms contained hand soap, paper towels, toilet paper and trash bins with lids. The hot water temperature was measured at approximately 10:50am to be 107.1 degrees Fahrenheit. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. LPA observed non-skid mats and grab bars inside the bathrooms. Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested by staff at 11:30am and were observed to be operational. Garage: There is a garage in the premises and is currently being used for storage and as office space. Laundry Room: Functioning washer and dryer are in a separate laundry room located next to the kitchen area. Laundry detergents and other chemical supplies were observed to be locked and inaccessible to residents in care. Backyard/Front yard: LPA observed sufficient yard space and fenced backyard with appropriately covered shaded area available for clients to rest. There is outdoor furniture under the shaded area. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. During the physical walk through LPA observed all exit areas to be clutter and obstruction free. There is a pool in the property with proper locked gates. Staff/Client File review: Facility records are kept in the office area next to the living room. Between 10:55am -11:45am LPA conducted records review of three (3) staff files and three (3) residents’ records. Files were complete and updated. Continue On LIC809D Medications : At approximately 11:50am, LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. The facility also maintains Medical Administration Records (MAR). LPA observed centrally stored medications locked inside the medication cabinet and inaccessible to residents in care. Complete First-aid kit is also available and placed in the common area. No potentially dangerous items were found in the facility. The facility operates with two (2) shifts and has one -two (1-2) staff members for each shift. LPA conducted an interview with Co- Administrator and one caregiver, no residents were present in the house during the annual inspection. Facility plan/sketch is posted on the wall along with other posting requirements. LPA collected LIC500, LIC9020, and copy of Liability Insurance at the time of the visit. The facility is current with licensing fees. No Deficiencies issued during today’s visit. Exit interview conducted, a copy of this report signed and delivered.