Routine inspection·November 8, 2023

Licensing Program Analyst (LPA) Abeye Duguma met with Jocelyn Sinon for a One (1) Year Required annual inspection visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 09:40am and the following was noted: The facility has a total of five (5) bedrooms, five (5) of which are designated for resident use. Resident bedrooms were observed to be appropriately furnished. There are three (3) bathrooms in the facility and were observed to have non-skid mats and appropriate grab bars installed. The facility is fire cleared for five (5) non-ambulatory and one (1) bedridden resident. The facility is currently occupying four (4) residents present in the facility of which three (03) are receiving hospice services. All residents appear to be clean and groomed. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage and laundry. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. Living and dining room furniture were also checked. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 75°F. (continued on LIC 809-C) The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is in the kitchen, observed to be full and last purchased on 09/22/2023. The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 114.8°F. Towels and washcloths are not shared. There was enough clean linen available in the hallway cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted. Exit interview was conducted and with a copy of this report was issued.