Routine inspection·April 27, 2026

At 9:45 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff Nora Karapatyan and the Administrator was contacted via telephone. LPA explained the reason for the visit. Physical tour was conducted with the Administrator and LPA observed the following: Kitchen: At 9:55 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 drawer. LPA observed a fire extinguisher hanging on the wall by the kitchen and was purchased on 04/27/2026. Medications: At 10:00 AM LPA observed medications are centrally stored and locked in a closet in the hallway and inaccessible to residents in care. During the medication review, LPA could not verify the accuracy of the medication administration due to the lack of incomplete Centrally Stored Medication Record (CSMR) Form. Administrator informed LPA that the Administrator did not complete the form and was unable to provide a reason. Bedrooms: The facility has six (6) bedrooms in total. All bedrooms were clean and odorless. Furniture was in good repair. Bedroom #3 was designated for a bedridden resident. One of the bedrooms located near the kitchen is designated for staff and LPA observed free of hazard and obstruction. LPA observed full bed rails for Resident #5 (R5), in bedroom #2 without Physician's order on file. Continue on LIC 809C Bathrooms: The facility had 3 bathrooms. Bathrooms #1 located by the entrance is designated for staff. All bathrooms contained paper towels and liquid soap. Bathroom #3 is attached to bedroom #6. Bathrooms have grab bars and a non-skid mat. Hot water temperature measured at 119.8°F. Common Areas : The facility maintains a comfortable temperature at 70°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. Garage: LPA observed the garage to be locked and inaccessible to residents in care where the facility kept cleaning supplies, hazardous liquids, detergents, and extra PPE accessible to residents in care. LPA observed an extra refrigerator for staff and residents. Laundry: The laundry is located between the kitchen and garage. LPA observed the laundry to be locked and inaccessible to residents in care. Outside and Back Yard: LPA toured the two side paths and back yard. Both emergency exit gates were unlocked, and paths were free from debris. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Smoke detectors/carbon monoxide . Smoke detectors were located throughout the facility, and at 10:00 AM, they were tested and observed to be operational. Carbon monoxide was living room and was also tested and observed to be operational. LPA heard functioning auditory alarms on all exit doors. Between 11:00 AM to 1:30 PM, LPAs reviewed records of six (6) residents, two (2) staff, and the Administrator. R2's file was missing Appraisal Needs and Services Plan (LIC 625), R3's LIC 625 was last updated on 02/05/2025. R5's LIC 625 was last updated on 02/05/2025. Staff records/files were completed and updated. On 04/15/2026, the LPA was notified via email by a credible witness of ongoing construction work on the facility’s roof. The LPA subsequently contacted the facility’s Administrator by telephone, who confirmed that the construction was being conducted due to a leak. The Administrator also confirmed that the Regional Office had not been notified prior to the construction or modification of the facility’s roof. Continue on LIC 809C Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Deficiencies cited during today’s visit. Appeal rights issued and given. Exit interview conducted and copy of this report signed and delivered.