Routine inspection·September 10, 2025

On 9/10/2025 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Administrator Anahit Ohanyan, who granted access to the facility. LPA explained the reason for the visit. LPA Khurshudyan reviewed the required postings on the hallway next to the entrance area and requested staff and residents’ rosters for review. The inspection tool was used to complete the visit. At 11:45am LPA, with the help of the Administrator, began a physical plant tour of the facility and the following was observed: This is a single-story building with four (4) bedrooms, all rooms designated for residents’ private use. There are two (2) bathrooms, a kitchen, common areas: living and dining rooms, and an outdoor area. Facility has an approved fire clearance for six (6) Non-ambulatory residents, of which 1 may be Bedridden for bedroom #3, and a Hospice waiver for five (5) residents. Kitchen: LPA observed a seven-day supply of non-perishable food, and a two-day supply of perishable food properly stored and labeled. No expired food was observed. Facility stores knives and sharps inside the locked kitchen cabinet. Emergency supply of food / water was stored inside the pantry. Food storage and preparation areas are clean and inaccessible to pests. LPA observed one (1) fire extinguisher located in the kitchen wall. The fire extinguisher was last serviced on 5/5/2025. A weekly menu was also available for clients. Second refrigerator was placed in the backyard for additional food. Dish soap and other chemicals were properly stored and locked under the kitchen sink. Continue on LIC809-C Bedrooms: There are four (4) bedrooms in the facility. All bedrooms are for private use. LPA observed bedrooms to be properly furnished with beds, linens, night stands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. Residents have enough personal hygiene products. Common Areas: These include living and dining areas . LPA observed dining, living areas clean and clear of clutter. Furniture is generally new and in a good repair. Dining and living room furniture sits at the capacity of the facility. Walls, floors, windows, screens, and blinds were clean and in good repair. At 11:55am, LPA measured the room temperature to be 78 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found throughout the facility. Facility has landline, LPA checked it was operational. There is a television, cabinet for activities, and art supplies available for clients’ use. Bathroom: There are two (2) bathrooms in the facility. The bathrooms contained hand soap, paper towels, toilet paper and trash bins with lids. The hot water temperature was measured at approximately 12:00pm to be 118.4 degrees Fahrenheit. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested by staff at 2:15pm and were observed to be operational. Garage: There is no garage on the property. Garage is converted to an ADU. LPA received all required documents and permits. Laundry Room: Functioning washer and dryer are located in a separate laundry room located next to the kitchen area. Laundry detergents and other chemical supplies are locked and inaccessible to clients in care. Backyard: LPA observed sufficient yard space and fenced backyard. Appropriately covered shaded area available for clients to rest. There is outdoor furniture under the shaded area. LPA discussed the importance of maintaining care and supervision to meet the needs of clients. All exit doors were unlocked; no obstructions observed around the emergency exit area. There is no body of water in the property. Staff/Client File review: Facility records are kept inside the locked storage closet located in the hallway. Between 12:20pm -1:50pm LPA conducted records review of five (5) staff files and five (5) residents’ records. Files were complete and updated. Continue on LIC809C Medications : At approximately 1:55pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. The facility also maintains Medical Administration Records (MAR). LPA observed centrally stored medications locked inside the medication closet and inaccessible to residents in care. Complete First-aid kit is also available and placed in the common area. No potentially dangerous items were found in the facility. The facility operates with two (2) shifts and has two (2) staff members for each shift. LPA conducted an interview with an Administrator, one (1) caregiver and three (3) out of five (5) residents who were able to communicate. Facility plan/sketch is posted on the wall along with other posting requirements. LPA collected LIC500, LIC9020, and a copy of Certificate of Liability Insurance. Liability Insurance - Exp 3/20/2026 The Administrator's certificate - Exp date is 6/28/2027. No Citations issued during today’s visit. Exit interview conducted. Copy of this report provided.