Routine inspection·July 15, 2025

At 12:00 PM, Licensing Program Analyst (LPA), Huma Rahimi conducted an unannounced annual inspection visit to the above facility and met with the staff Arman Arinov and the Licensee was contacted via telephone. LPA explained the reason for the visit. The Licensee arrived shortly after. LPA and the Licensee conducted a physical tour of the facility and observed the following: KITCHEN: LPA observed a Kitchen area that is equipped with a refrigerator, microwave oven, and a sink. Stove was observed in a good working condition. At 12:10 PM, LPA observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents in care. Fire Extinguisher was last purchased on 07/15/2025. MEDICATION ROOM: The centrally stored medication is locked and inaccessible to residents in care in the kitchen cabinet. LPA observed vitamins and supplement in one of the kitchen cabinets and more medication in the laundry room in a plastic cabinet unlocked and accessible to residents in care. LAUNDRY ROOM: The laundry room is located next to the kitchen. Laundry and other cleaning supplies are kept inaccessible in a standing closet in the laundry room. LPA observed the closet is locked. The washer/dryer appear to be in good condition. Continue on LIC 809C BEDROOMS: There are three (3) bedrooms designated for resident’s use. All bedrooms are shared. Bedroom (2) is used for a bedridden resident. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. Facility will have a no live-in staff at the facility. BATHROOMS: There are two bathrooms at the facility of which one is designated for resident’s use. At 12:20 PM, LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and had non-skid mat The water temperature was noted at 108.7°. COMMON AREAS: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. SURROUNDING GROUNDS: The back of the facility has sufficient yard space. LPA did observe appropriate outdoor furniture, LPA observe a covered shaded area for residents . The backyard is fenced. There is no swimming pool or any bodies of water at the facility. The exit was free of any obstruction or hazard. Garage/Storage: LPA observed that the garage is being used for office supplies storage. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:05 am they were tested and observed to be operational. Between 1:15 PM to 2:30 PM, LPA reviewed records of three (3) residents and one (1) staff. LIC 625 (Appraisal Needs and Services Plan) were on file; however, they were observed incomplete. Staff file, training including CPR/First Aid training and health screening (no TB Test) was incomplete and not updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Deficiencies cited during today’s visit. Appeal rights explained. Exit interview conducted and copy of this report signed and delivered