Routine inspection·February 18, 2025

Licensing Program Analyst (LPA) Gary Tan initially met staff Rysbubu Kerimbekova who called the co Administrator Andranik Ter-nersesian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. The co Administrator designated Ms. Kerimbekova to sign the report. A tour of the physical plant was conducted at 12:22 PM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the front yard. The facility has sufficient stock of PPE in the storage room. The facility has four (4) bedrooms and two (2) bathrooms currently occupying three (3) residents. One (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, one (1) of which may be bedridden on Room #2 . Hospice waiver for four (4) residents. Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide installed at the facility. Fire extinguisher is located in the dining area and observed to be full and last bought on 10/03/24. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C) (continued on LIC 809-C) There is no garage at the facility, only car port located at the front and side. There is a sitting area in the front yard for residents to conduct outdoor activities. There is a shed at the backyard being used as a storage for frozen food, PPE and other supplies. Laundry area is located at the back. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at 113.9°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet. Medications : LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. There is a complete first aid kits located in the kitchen. Client records : Client records are reviewed. Client records appear to be complete and updated. Staff records : LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 12/16/24 . Required posting observed in facility (complaint hot line poster). Exit interview conducted. Copy of this report issued.