Routine inspection·November 6, 2025

On 11/6/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival LPA was greeted by the Caregiver Champo Chilambwe , who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. The facility Administrator Mariam Balasanyan was contacted by phone and informed about the visit. LPA Khurshudyan reviewed the required postings on a wall throughout the facility. The inspection tool was used to complete today's visit. At 10:25am LPA, with the help of the caregiver, began a physical plant tour of the facility and the following was observed: This is a single-story building with six (6) bedrooms, two (2) bathrooms, kitchen, common areas, and outdoor areas. This facility is operating as RCFE, has an approved fire clearance for six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility also has approved Hospice waiver for six (6) 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 kitchen cabinet. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed two (2) fire extinguishers in the facility, one (1) located in the hallway, and one (1) next to the kitchen area with a last service date 11/6/2025. A weekly menu was also available for clients and was posted on the fridge. Bedrooms: There are six (6) bedrooms in the facility designated for residents’ use, the office is in the living area. All bedrooms are for private use. LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. Continue on LIC809-C 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 11:00am LPA measured the room temperature to be 72 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found throughout the facility. Facility has landline, LPA checked it was operational. There is a television, cabinet for activities, and art supplies available for clients’ use. Bathroom: There are two (2) bathrooms in the facility. The bathrooms contained hand soap, paper towels, toilet paper and trash bins with lids. The hot water temperature was measured at approximately 11:15am to be 117.9 degrees Fahrenheit. LPA also observed required signs on the bathroom walls and non-skid mats inside the showers. Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested by staff at 11:25am and were observed to be operational. Garage: There is no garage on the property. Laundry Room: Functioning washer and dryer located in the backyard, inside a separated space. Laundry detergents and other chemical supplies are locked inside the cabinets placed in the laundry space. LPA observed all chemicals were inaccessible to residents in care. Backyard: The backyard is fenced and has sufficient yard space. Appropriately covered shaded area available for residents use. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. Entry / Exit doors were unlocked and free of obstructions. There is no body of water in the property. Staff/Client File review: Facility records are kept inside the locked commercial cabinets located in the office area. Between 11:30am -12:35pm LPA conducted records review of three (3) staff files and four (4) residents’ records. Files were complete and updated. Continue on LIC809-C Medications : At approximately 12:45pm. 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 kitchen cabinet and inaccessible to residents in care. Complete First-aid kit is in the office area, new manual for first aid kit was also available. No potentially dangerous items were found in the facility. The facility operates with two (2) shifts and has one to three (1-3) staff members for each shift. Three out of four residents were present during the visit; LPA interviewed Administrator, Caregiver, and three (3) residents. Facility plan/sketch is posted on the entrance wall along with other posting requirements. LPA collected LIC500, LIC9020, the Copy of Administrator Certificate, and a copy of the Liability Insurance Ex. 12/20/2025. The Administrator's certificate - Exp date is 1/16/2027. No citations issued during today's visit. Exit interview conducted. Copy of this report provided.