Routine inspection·September 18, 2025

At 09:15am Licensing Program Analyst (LPA), Angela Panushkina conducted an announced annual visit to the above facility. LPA met with the Designee, Rena Danielyan, and explained the reason for the visit. A tour of the physical plant was initiated at 09:30am and the following was observed: The facility is cleared for a maximum capacity of six (6) residents, of which five (5) can be Non-ambulatory and one (1) Bedridden resident. Bedridden is cleared for bedrooms #1, #2 and #3. Facility has Dementia Care Program. Hospice waiver for six (6) residents is also approved. Kitchen: The kitchen area is equipped with a refrigerator, microwave oven and sink. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives were observed to be locked in the kitchen drawer. The fire extinguisher was purchased on 01/10/2025 and located by the dining area. Bedrooms: The facility has a total of five (5) bedrooms, designated for residents’ use. The bedrooms are appropriately furnished with sufficient closet space and have sufficient lighting. Facility has awake staff at night. Emergency call buttons are available and provided to residents. All exit doors have an auditory alarm. LPA tested and observed all call buttons and auditory alarms are in good repair and operational. Bathrooms: Three (3) out of four (4) bathrooms are designated for residents’ use. Bathrooms have soap, paper towels and all trash cans have a lid. Extra towels and linens were readily available. LPA observed appropriate grab bars and non-skid mats in all bathrooms. The hot water temperature measured at 110.0°F. The facility has one (1) more bathroom (for staff use only), located by the garage. Continue on LIC809-C Medications: The medication are centrally stored in the hallway cabinet, by room #3 and kept locked and inaccessible to residents in care. LPA also observed a small, locked refrigerator, under the medication cabinet, that will be used to store medications only (if needed). There is a complete first-aid kit in the cabinet with all required supplies and with the first aid manual. Common Areas: The facility maintains a comfortable temperature at 78°F. LPA observed all common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. There is a functioning telephone on the premises. Smoke detectors carbon monoxide is located throughout the facility and at 1:00pm they were tested and observed to be operational. Laundry: The laundry is located in the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Outside Area: The back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a shaded area covered for the residents. The outdoor area is free of visible immediate hazards. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. There are no bodies of water. Between 10:30am to 11:30am, LPA reviewed records of three (3) residents and three (3) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentation. Annual fee is paid in full. LPA observed Administrator certificated renewed on 11/17/2024 with an expiration date of 11/26/2026. LPA collected Certificate of Liability Insurance and LIC500. No citations were issued during this visit. Exit interview conducted and copy of this report signed and delivered.