Routine inspection·May 2, 2025

On May 2, 2025, Licensing Program Analyst (LPA), Deborah Lee conducted an unannounced annual required visit using the CARE Inspection Tool. LPA Lee met with Myrna Ma and the purpose of today’s visit was explained. The facility is licensed to serve six (6) residents, all of which (6) may be non-ambulatory with a hospice waiver approved for four (4) aged 60+ years. The Annual Licensing Fees are current. Physical Plant/Structure : The one-story residential home consists of four (4) resident bedrooms, one (1) resident bathrooms, living room, dining room, family room, kitchen, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. The facility is clean, sanitary, and in good repair. Licensee accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Page 1 of 2 Bedrooms: LPA inspected all 4 bedrooms; the mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom s: Resident bathroom was checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid material was in place, hot water temperature properly measured 114 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common Rooms Common areas were clean and clear of hazards, doorways were free of obstructions. First Aid kit was available. 3 fire fully charged fire extinguishers were observed in the kitchen area, the living room area. Staff tested smoke/carbon monoxide detectors they were operational. Required Postings: LPA observed all required documents posted throughout the facility. Page 2 of 3 Kitchen: LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored, packaged, and labeled. Knives and toxins were kept locked and inaccessible to residents in care. Safety: LPA observed 3 fully charged fire extinguishers . Emergency disaster plan updated 5/2/25. Smoke detectors/Carbon monoxide detector tested and is operational. File Review: LPA reviewed ( 5 ) resident files and found that ( 5 ) out of (5 ) had the required documents. LPA reviewed ( 4 ) staff fields and found that ( 3 ) out (4) had the required documents, training, and certifications. The 3 out of 4 needed to update CPR/First Aid. Medications LPA observed all centrally stored medications secured. All medications were observed in their original packaging. LPA reviewed a copy of the facility’s Liability Insurance which expires on 4/29/2026 During today’s visit there were no deficiencies issued. There was Technical Advisory note issued. See LIC 9102. An exit interview was conducted with Myrna Ma and a copy of this report was provided . Page 3 of 3