Routine inspection·May 19, 2025

Licensing Program Analyst (LPA) Lorena Casillas conducted the unannounced annual inspection. LPA met with Licensee/Administrator, Kristina Adamyan and explained the purpose of the visit. The facility is licensed for 6 non-ambulatory residents, of which 1 may be bedridden. Bedroom #3 is approved for bedridden. Facility has a hospice waiver approved for 5 residents. LPA conducted a facility tour at 11:30 am with the Administrator and the following was observed: Currently there are three (3) residents in the facility two (2) of which were present and one (1) was out in the community. Infection Control: LPA reviewed facility infection control plan to make sure licensee was following current infection control recommendations. Infection control plan last updated on 05/01/2024. Kitchen : LPA conducted a tour of the kitchen at 11:30 am and observed there to be sufficient stock of two-day perishable and seven-day non-perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. Medication and knives are stored in locked cabinets. First aid kit furnished and fully equipped. Common Areas : LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 71°F. LPA observed staff and client files locked in the filing cabinet. The smoke detectors and carbon monoxide detectors were tested and observed to be operational. There is one (1) fire extinguishers located in the kitchen hallway. The fire extinguishers was observed to be full however it was last serviced on 03/15/2023. Administrator purchased and had a new fire extinguisher delivered during visit. Continued on LIC809-C Bedrooms: The facility consists of four (4) resident rooms and one (1) staff room. LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each client. LPA observed sufficient linens and towels in the hallway closet. All windows had adequate screens, and egress was functioning in all the rooms. Bathrooms : The facility consists of two (2) bathrooms. LPA observed bathrooms to have the appropriated wash your hands signs posted. The bathrooms were clean, with soap and paper towels for residents. Hot water was tested and measured within regulation at 108.6˚ F. Surrounding Grounds : There were no visible hazards, and passageways were free from obstruction. There is a covered patio and sufficient furniture for all residents. Garage entrance was locked and secure. Garage contains PPE equipment, an additional refrigerator and is used for storage. The laundry area is outside, and detergents are locked in a cabinet located outside as well. There is no swimming pool or bodies of water on the premises. Administrative: LPA collected LIC500, Liability insurance, Administrator certificate and resident roster. Annual fees are current. Staff and Resident Interviews: LPA interviewed residents at 12:00 pm. LPA interviewed staff at 12:30 pm. Resident Files : LPA conducted a file review of staff records at 01:00 pm. Staff Files : LPA conducted a file review of resident records at 01:30 pm. Medications : At 02:05 pm LPA and Administrator reviewed medication and medication records for proper documentation. No deficiencies were observed, an exit interview was conducted, and a copy of this report was given to the Administrator.