Routine inspection·May 15, 2025

On 5/15/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Caregiver Naira Khachatryan, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall next to the entrance area. The Administrator Rima Agaronyan arrived shortly after. The inspection tool was used to complete the visit. At 10:25am. LPA with the help of Administrator 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 four (4) bedrooms are designated for residents’ use and one bedroom designated for staff use only. There are two (2) bathrooms, kitchen, common areas: living and dining rooms, and outdoor areas. It has an approved fire clearance for six (6) Non-ambulatory residents, of which one (1) may be Bedridden bedrooms #2 or #4. Facility also has Hospice waiver for five (5) residents. Common Areas : The facility maintains a comfortable temperature at 74°F. The living room and dining area appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility was observed. Kitchen: At approximately 10:40am 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. Sharps/knives were properly stored and locked inside the kitchen cabinet. There is a fire extinguisher on the kitchen wall which was last serviced on 09/07/2024. Chemicals observed to be locked under the sink and inaccessible to residents in care. Continue on LIC809-C Bathrooms: At 10:50am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 115.8°F. LPA observed appropriate grab bar and non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. Smoke detectors/carbon monoxide . Dual smoke and carbon monoxide detectors were located throughout the facility, and at 11:05am they were tested and observed to be operational. Outside areas: At approximately, 11:20am LPA toured the outside area of the facility and observed appropriate outdoor furniture, with a covered shaded area for residents LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Laundry Room: Laundry machines are in a separate locked area close to bedroom #4. Disinfectants, laundry detergents and hygiene supplies were stored and inaccessible to residents in care. Extra linens were also stored and readily available. Garage: There is no garage in the property. LPA observed two (2) storages outside in the property where extra supplies and maintenance is stored. Between 11:45am to 2:00pm, LPA reviewed records of six (6) residents and five (5) staff members. Resident and staff records appeared to be complete and updated. MEDICATION: LPA observed centrally stored medication and First Aid kit locked inside separate storage located in the hallway and inaccessible to residents in care. LPA observed First-aid kit is complete and has new manual. Facility has Dementia Care Program. PRN medications have written orders from a physician. The facility serves residents with dementia and facility has trained staff to meet the needs of residents who are diagnosed with dementia. Facility has two (2) staff for AM shift and two (2) awake caregivers for PM shift, there is one (1) caregiver on call. Administrative: Annual fee is current. All required signs are posted. LPA collected LIC500, LIC9020 and Certificate of Liability Insurance. The Administrator Certificate expires on 10/1/2026. No citation issued during this visit. Exit interview conducted. Copy of report signed and delivered to the Administrator.