Routine inspection·January 9, 2026

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Jennifer Discipulo and Rafia Kaysha Dinda Oktiafaza, Caregivers and explained the purpose of the visit. At 1:30pm, Jasbindar Singh, Administrator arrived and assisted LPA. The facility is license to serve (6) n on ambulatory residents age 60 and above. Facility may retain (6) hospice residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are adhering to infection control requirements. The facility has an Infection Control Plan and reviews the infection control procedures in the facility annually. Operational Requirements: The Infection Control Plan has been added to the Plan. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and $3,000,000.00 in the total annual aggregate is valid, expires on 03/09/2026. Facility does not handle residents' cash resources. Physical Plant & Environment Safety: This facility is a single story home consists of (5) resident bedrooms, (1) staff bedroom, (3) bathrooms, living room, family room, kitchen, dining room and backyard. There are (4) residents residing in the home. Resident bedrooms were toured . All bedrooms have sufficient storage space and lighting. Bathrooms have grab bars and non-skid mats. Knives, cleaning solutions, and disinfectants are locked and inaccessible to residents. There is a carbon monoxide detector located near the kitchen and smoke detectors are operable. LPA observed a fire extinguisher near the family room which was last serviced on 02/18/2025. Water temperature readings are within the required 105 - 120 degrees Fahrenheit. Indoor passageways were kept free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and LPA observed boxes of miscellaneous items obstructing the passageways in the backyard and side yard. There is a sitting area with outdoor furniture but there is no umbrella or shade provided. *****Refer to LIC 809C for the continuation of this report.***** Staffing: A total of (4) staff members including the night staff and Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Current Administrator's certificate is valid, expires on 04/11/2027. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed (4) staff files including the Administrator. Proof of staff training, health clearance, and vaccinations are current. Dementia care is part of training for direct care staff. Resident Rights-Information: Resident rights are posted. Facility provides internet service and phone to the residents. Planned Activities: The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: There is sufficient food supplies of 2-day perishable and 7-day supplies of non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. There is one (1) resident with restricted diet residing at this facility. Incidental Medical Services: The medications are centrally stored and in their original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. Resident Records-Incident Reports: LPA reviewed (4) resident files. Residents files are maintained at the facility. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Special Incident Reports, Client Personal Property and Clients Personal Rights observed. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan which is posted. Disaster drills are conducted quarterly, last drill was conducted on 12/01/2025. Residents with SHN: Facility accepts and retains residents with dementia. Currently, there are (3) dementia residents and (1) hospice resident in the facility. Facility has sufficient space to permit residents with dementia to wander freely and safely. Administrator ensures that there is at least one night staff person awake and on duty for night supervision of residents with deme ntia. (1) of the residents using half bed rail did not have a physician's order on file. Deficiencies cited on LIC 809D, Technical Violations and Technical Assistance issued. Exit interview, appeals rights and a copy this report was provided to Administrator, Jasbindar SIngh .