Routine inspection·May 19, 2025

At 1:30 PM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual visit. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. It is a two story building with 6 bedrooms, 4 bathrooms, kitchen, garage, common areas, and outdoor areas. The second-floor stairway is locked and inaccessible to residents. It has an approved fire clearance for 6 non-ambulatory residents, of which 1 may be bedridden in Bedroom #1. Approved hospice waivers for six (6). The facility uses surveillance cameras on the exterior and in common areas. Kitchen: At approximately, 1:40 PM, LPA toured the kitchen area and observed an adequate supply of perishable and non-perishable food in the kitchen. Surfaces were sanitary and appliances were functional. The stove hood was free of debris. Sharps were locked by the refrigerator, and cleaning solutions locked in the laundry area which was next to the kitchen. The washer and dryer were in good repair and functional. Bedrooms: LPA observed total of six (6) private bedrooms designated for resident use. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has an awake staff. Medications: At 1:45 PM, LPA observed medications are centrally stored and locked in the hallway by bedroom # five (5) in a cabinet. Bathrooms: LPA observed four (4) bathrooms and all bathrooms appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and residents' bathroom had non-skid mat. Hot water temperature measured at 116.8°F. Continue on LIC809-C Common Areas : The facility maintains a comfortable temperature at 78°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. The facility does not have any garage. Smoke detectors/carbon monoxide . Smoke detectors were located throughout the facility, and at 1:50 PM they were tested and observed to be operational. LPA tested the dual functioning smoke and carbon monoxide detector in the living room to be operational. When tested, 4 out of 4 detectors functioned simultaneously and 2 out of 2 fire doors closed. LPA observed a fully charged fire extinguisher in the kitchen. It was purchased and inspected on 1/25/2025. Outside areas: At 1:55 PM LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. All emergency exit paths were free from obstructions. Between 2:10 PM to 3:20 PM, LPA reviewed records of four (4) residents and two (2) staff. Client and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency cited during today’s visit. Exit interview conducted and copy of this report signed and delivered.