Routine inspection·October 28, 2024

At 01:00 PM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual visit. LPA met with the Administrator Designee Rima Agaronyan, and disclosed the reason for the visit. LPA and the Administrator Designee toured the facility inside and out. Kitchen: At 1:18 PM, LPA and Administrator Designee toured the kitchen and the kitchen is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives were observed locked in the kitchen drawer. MEDICATIONS: LPA observed the medication locked and inaccessible to residents in care in a cabinet in the dinning room; however, bedroom # (1) closet of a resident had two Ziplock bags filled with medications of one of the caregivers accessible to the resident in care. Additionally, LPA observed more medications in all residents bedrooms accessible to residents in care. SAFETY: The smoke alarms and carbon monoxide detector are battery operated. The facility has a fire extinguishers that was purchased on 09/07/2024. One fire extinguisher is located on the kitchen wall. BEDROOMS: There are five (5) bedrooms designated for resident’s use. Bedroom # (3) is shared. All other four (4) bedrooms are private. Bedroom number one is cleared for bedridden. All other rooms are cleared for non-ambulatory. All bedrooms are furnished with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has three (3) bathrooms. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 116.08 degrees. Continue on LIC 809C COMMON AREAS: These included the TV and activity room which were equipped with living room furniture, a television, tables and chairs. The dining area has a large dining room table to accommodate six (6). There were no visible immediate hazards. LAUNDRY ROOM: The laundry room is located in the in the hall. All the cleaning supplies and detergents were observed locked in a storage area in bedroom # (3). OFFICE/STAFF WORKSTATION: Staff workstation is located at the entrance of the facility. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. The backyard of the facility has a patio and outdoor furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is only one emergency exit and LPA observed free of obstruction and hazard. The gate had a inward latch. Between 3:00 PM to 4:00 PM, LPA reviewed records of three (3) residents and two (2) staff. Residents and staff records appeared to be complete and updated Administrative: LPA collected Certificate of Liability Insurance, and LIC500. A deficiency cited during today’s visit. Appeal Rights explained. Exit interview conducted and copy of this report signed and delivered.