Routine inspection·November 17, 2025

At 10:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual visit. LPA met with Lourdes Zapata, Caregiver, who granted access to the facility. The Administrator Marine Grigoryan was contacted via a telephone and LPA explained the reason for the visit. The Administrator arrived at the facility at 11:00 AM. LPA was informed that the facility currently has six (6) residents, of which two (2) residents are non-ambulatory. Three (3) residents are currently on hospice. Facility has waiver for 4 hospice residents. KITCHEN: LPA observed the kitchen area equipped with a refrigerator, microwave oven, and a sink. Stove was observed in a good working condition. At 11:10 AM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents in care. LPA observed a Fire Extinguisher and was purchased on 11/17/2025. It was observed hanging on the wall by the bathroom in the main hall. MEDICATION ROOM: The centrally stored medication are kept in the in a locked cabinet in the main hall by the kitchen. Residents and staff files are also kept in a cabinet locked and inaccessible in the main hall by the kitchen. During review of 23's random medication revealed that the facility was supposed to start Carvedilol 12.5MG (Hypertension Medication) a new bottle on 10/16/2025. During today's visit LPA counted R2's medication and it was discovered that there was a discrepancy and twenty two (22) extra pills were in the bottle. LPA asked the Administrator and the staff for explaining and both staff and the Administrator could not provide any answers . Continue on LIC 809C BEDROOMS: There are four (4) bedrooms designated for resident’s use. Two (2) bedrooms are shared and two (2) are private. Bedroom #4 is for bedridden resident. LPA observed that the bedridden bedroom exit was being blocked by a wheelchair. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. LPA observed Tylenol tablets, and Mylanta liquid in Bedroom #4 accessible and unlocked to residents in care. Auditory alarms were tested and observed to be non-operational. BATHROOMS: There are three (3) bathrooms at the facility. Two (2) out of three (3) bathrooms are designated for resident's use. One of the bathrooms is located at the end of the kitchen is only being used by the staff and visitors. Bathroom #1 is located in the hallway and bathroom # 2 is connected with bedroom #4. L PA observed all residents' bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 131.1°. LAUNDRY ROOM: The laundry room is located by the kitchen. All the cleaning supplies and laundry detergents were observed locked in a locked box in the backyard of the facility. The washer/dryer appear to be in good working condition. COMMON AREAS: The facility maintains a comfortable temperature at 77°F. The living room and dining area appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility. SURROUNDING GROUNDS: The facility has sufficient backyard space. LPA did not observe any shaded area. LPA observed the furniture; however, they were not properly placed for residents to sit. The furniture were scattered around in the backyard. LPA observed a swimming pool which was locked and properly fenced. Garage/Storage: The facility does not have any extra garage/storage space. Continue on LIC 809C SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 11:30 AM, they were tested and observed to be operational. Between 12:00 PM to 2:00 PM, LPA reviewed records of six (6) residents and two (2) staff records. All residents and staff records were updated and completed. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Deficiencies issued and appeal rights explained. Exit interview conducted and copy of this report signed and delivered.