Routine inspection·November 4, 2025

Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual inspection visit to the above facility. LPA met the staff and Armine Dishoyan the Designee was contacted via a telephone. LPA explained the reason for the visit. At 9:50 AM the designee arrived at the facility. LPA and the designee conducted a physical plant tour and observed the following: LPA observed the required postings in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. It was last serviced on 08/30/2025. During the visit the facility is at 69 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; six (6) hospice waiver. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. All sharps/knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the kitchen cabinet under the sink. Bedrooms: There were four (4) bedrooms designated for residents' use. Bedroom #1 and bedroom #4 is shared. Room #2 and bedroom #3 of the bedrooms are private. All the bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue on LIC 809C Bathrooms: There are two (2) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 114.4 degrees Fahrenheit for bathroom #1 located in the hallway beside room #2. There was enough clean linen available in the cabinets in the hallway. MEDICATION ROOM: The centrally stored medication are observed in the hallway in a locked cabinet inaccessible to residents in care. LPA reviewed records and medication of the residents and did not observe any discrepancies. Common Areas: COMMON AREAS: The facility maintains a comfortable temperature at 69°F. The living room and dining area appeared clean and were properly furnished and has a television. No obstructions and or tripping hazards throughout the facility. LPA observed a working telephone for the facility. Surrounding Grounds : Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility has a swimming pool, it's fenced and lock. The garage attached and is used for storage. Laundry Area: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the garage. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:00 AM, they were tested and observed to be operational. Between 10:30 AM to 11:45 AM, LPA reviewed records of three (3) residents and two (2) staff. All residents and staff records were updated and completed. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency observed and issued during today's visit. Exit interview conducted. Copy of this report signed and delivered.