Routine inspection·July 17, 2025

At 9:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual inspection. Upon arrival, LPA met with Staff #1, who granted access to the facility. The Designee, Nina Blayan, arrived shortly after and LPA explained the reason for the visit. At 9:40am LPA conducted a tour of the physical plant and observed the following: The facility is licensed for capacity of six (6) residents. The fire clearance is approved for five (5) Non-Ambulatory in rooms #1, #2, #3 and #4, of which one (1) may be Bedridden In room #5. The facility also has approved hospice waivers for six (6) residents. Bedrooms are appropriately furnished and have appropriate lighting. LPA observed Resident #4 in bedroom #3. Based on a fire clearance approval and review of R4’s Physician’s Report, R4 must reside in bedroom #5. The facility has awake staff. Bathrooms have soap and paper towels. Extra towels and linens were readily available. The hot water temperature measured at 116.1°F. Facility maintains a temperature of 77°F. 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. The fire extinguisher is located in the kitchen and was last purchased on 05/14/2024. 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. All chemicals and detergents are kept in the garage and inaccessible to residents in care. LPA observed all medications locked in the hallway closet. Smoke detectors and carbon monoxide monitors were tested at 10:50am and observed to be functional. At 11:00am, LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Continue on LIC809-C LPA discussed the importance of maintaining care and supervision to meet the needs of residents. Between 11:30am to 12:30pm, LPA reviewed records of five (5) residents and four (4) staff. Resident and staff records appeared to be complete and updated. The annual fee is paid in full. LPA observed Administrator certificate last renewed on 01/22/2025 with an expiration date of 01/21/2027. LPA collected the Certificate of Liability Insurance and LIC500. Citation issued on LIC809-D during this visit. Exit interview conducted and a copy of this report signed and delivered.