Routine inspection·March 12, 2026

At 9:45am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced required annual visit. LPA met with staff, later Administrator Nino Smith arrived and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility is a single-story building with 7 bedrooms, 3 bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (6) residents, of which 6 may be non-ambulatory, of which all 6 residents can be bedridden. The facility serves residents with dementia. Approved hospice waivers for 6 residents. Kitchen: At approximately 10:50am, 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. Kitchen surfaces were sanitary, and all appliances were functional. Sharps were locked below the counter, and cleaning solutions were locked in separate cabinet in the kitchen. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 9/9/2025. Medications: At approximately 12:45pm, LPA observed medications are centrally stored and locked inside the kitchen cabinet. LPA also observed an additional locked cabinet where resident and staff files are kept. Bedrooms: LPA observed total of seven (7) bedrooms of which six (6) are designated for residents’ use. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has awake staff. Bathrooms: LPA observed five (5) bathrooms, and all bathrooms appeared to be clean and in good repair. Properly supplied with toilet paper, soap and paper towels. LPA observed appropriate grab bar and all bathrooms had non-skid mats. LPA observed appropriate hand-washing signs posted in each bathroom. At 11:15am, hot water temperature measured at 107.4°F. Continue on LIC809-C Common Areas : The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, and comfortable furniture. No obstructions or tripping hazards throughout the facility. LPA observed an operable washer and dryer placed inside the locked garage. All detergents were also stored and locked. Extra emergency food and water was also readily available for residents in care. Smoke detectors/carbon monoxide . At 12:55pm, LPA tested the dual-function smoke and carbon monoxide detector to be operational. When tested, 3 out of 3 detectors functioned simultaneously, and the fire door closed. Outside areas: At approximately 11:35am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is no bodies of water or swimming pool at the facility. All emergency exit paths were free from obstructions. Exit gates were unlocked. Between 11:00am to 12:45pm, LPA reviewed records of six (6) residents and four (4) staff. Resident and staff records appeared to be complete and updated. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. Facility also maintains Medical Administration Records (MAR). LPA observed centrally stored medication, and First Aid kit locked in the commercial cabinet and inaccessible to clients in care. LPA observed First-aid kit is complete and has new manual. PRN medications have written orders from a physician. During CSMDR / MAR / Medication review, LPA conducted medication count and noted Resident #4’s (R4) medication quantities on hand did not match the amounts listed on the CSMDR order. Potentially dangerous items are kept inaccessible to residents in care. Facility operates with two (2) shifts and has two (2) staff members for each shift. An emergency exit plan/sketch is posted on the wall along with other posting requirements. LPA interviewed the Administrator and two (2) Caregivers, one (1) resident who agreed to answer questions. LPA collected LIC500, LIC9020, Certificate of Liability Insurance. The Administrator's certificate - Exp date is 12/5/2026. Citation issued during today's visit, see LIC809-D. Exit interview conducted and copy of this report signed and delivered.