Routine inspection·September 16, 2025

Licensing Program Analyst (LPA) Jose Tan met administrator Daniel Alexandryan for a One (1) Year Required visit for this facility. LPA observed that all six (6) residents were at the facility during the visit. A tour of the physical plant was conducted at 3:18 PM and the following was noted: There is only one entrance being utilized at the facility, there is a required poster posted at the main door. The screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a total of five (5) bedrooms and three (3) bathrooms. One bedroom is located in the converted garage that is designated for staff use only. Another bedroom is designated for staff use. One (1) bathroom is designated for staff use only. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden. Hospice waiver for six (6) residents. Living and dining room furniture were also checked. Dual smoke/carbon monoxide detectors are hardwired and interconnected and observed to be operational. The fire extinguisher is located in the kitchen and observed to be full and last purchased on 04/30/25. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C) (continued from LIC 809) There is no garage at the facility, only car port located at the front. The garage was converted into an office for staff use. It has access both outside and inside the house but it has lock for security purposes. There are two (2) tools shed located, one in the front driveway and the other at the backyard, both tool sheds were observed to be locked and inaccessible to residents. Laundry area is located adjacent to the kitchen. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry area. Food Service/Kitchen, the facility has sufficient perishable food in stock for two (2) days and has non-perishable food for seven (7) days in stock. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. Linens and towels are sufficient in stock in the bedroom hallway cabinet. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at 108.6°F Medications : The medication cabinet is located in the living room and was observed to be locked. There is a complete first aid kit located in the kitchen. Client records : All six (6) residents records were reviewed and observed to be complete and updated. Staff records : Three (3) staff records were reviewed and observed to be complete and updated. Disaster Drill was last conducted on 06/23/25. Required posting observed in facility (complaint hot line poster). There are no health and safety issues observed during this visit. Exit interview conducted. Copy of this report issued.