Routine inspection·May 7, 2026

On 5/7/2026 Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct the required Annual Inspection. Upon arrival, LPA was greeted by the Staff, who granted access to the facility. LPA explained the reason for the visit. LPA Khurshudyan reviewed the required postings posted on the entrance wall and throughout the facility. Administrative Assistant Viktorya Hayrapetyan arrived shortly after. At approximately 10:05am LPA requested staff and residents’ rosters for review. The inspection tool was used to complete the visit. At 10:35pm LPA, with the help of the Staff, began a physical plant tour of the facility and the following was observed: This is a single-story building with four (4) bedrooms, and all rooms are designated for residents’ use only. There are three (3) 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, all of which one (1) may be bedridden for bedroom #4, and a Hospice waiver approval for six (6) 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. Sufficient amount of emergency supply of food / water was readily available inside the kitchen cabinet. Food storage and preparation areas are clean and inaccessible to pests. LPA observed one (1) fire extinguisher located on the kitchen wall. The fire extinguisher was last serviced on 6/13/2025. Dish soap and other chemicals were observed to be stored under the sink inside the locked cabinet and inaccessible to residents in care. Continue on LIC809-C Bedrooms: LPA observed bedrooms to be properly furnished with beds, linens, nightstands, chairs, drawers, closets, and adequate lighting. All bedrooms appeared organized and clean. Residents have enough personal hygiene products. During the visit, the LPA observed that a bedridden resident is occupying bedroom #3; however, according to the approved fire clearance, the resident must be inside bedroom #4. 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 11:05am, LPA measured the room temperature to be 73 degrees Fahrenheit. There is a linen closet with an adequate supply of fresh linens ready to use. No obstructions and or tripping hazards found inside the facility. Facility has landline, LPA checked it was operational. Bathroom: The bathrooms contained hand soap, paper towels, toilet paper and trash bins with lids. The hot water temperature was measured at approximately 11:15am to be 117.1 degrees Fahrenheit. The bathrooms were checked for cleanliness and proper operations. Towels and washcloths are not shared. LPA observed non-skid mats and grab bars inside the bathrooms. Smoke and Carbon Monoxide Detectors: The smoke and carbon monoxide detectors were tested by staff at approximately 11:35am and were observed to be operational. Garage: There is no garage in the property. Laundry Room: Functioning washer and dryer is located in the separate laundry area next to the kitchen. Laundry detergents and other chemical supplies observed locked inside the laundry room cabinet. Backyard/Front yard: LPA observed sufficient yard space and fenced backyard with appropriately covered shaded area available for residents 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. During the physical walk through LPA observed all exit areas to be free of clutter and obstruction. There is no body of water. Staff/Client File review: Facility records are kept inside the locked commercial/metal cabinet located in the living room. Between 12:30pm -1:35pm LPA conducted records review of six (6) staff files and four (4) residents’ records. Files were complete and updated. Continue On LIC809C Medications : At approximately 1:30pm, LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. LPA observed centrally stored medications locked inside the cabinet located in the living room and inaccessible to residents in care. Complete First-aid kit is available and is placed next to the entrance door . No potentially dangerous items were found in the facility. The facility operates with two-three (2-3) shifts and has one to two (1-2) staff members for each shift. LPA conducted interviews with the Administrative Assistance, two caregivers and two (2) out of four (4) residents who were able to communicate and answer questions. Facility plan/sketch is posted on the wall along with other posting requirements. LPA collected LIC500, LIC9020, and copy of Liability Insurance, and copy of Administrator certificate at the time of the visit. LPA also checked the Emergency Disaster Form and informed the facility to update the form and send the new copy to LPA. The Administrator certificate will be expiring on 8/17/2026. The Liability Insurance expires 4/30/2027. The facility has no outstanding balance of licensing fees. A Deficiency issued during today’s visit. See LIC809-D Exit interview conducted, a copy of this report signed, appeal rights explained and delivered.