Routine inspection·September 26, 2025

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct an annual inspection. LPA Allen was greeted by Annisa Wahyu-Support Staff upon arrival. LPA introduced herself and explained the purpose of the visit and LPA was allowed entry into the facility. At 9:00 AM, Aveil Nahum- Administrator arrived and he was informed of the purpose of the visit. The Fire Clearance granted on 07/12/2024 noted the following special conditions of approval: “Only 1 bedridden client allowed due to there being no sprinklers in the home. Bedrooms 2,3, and 4 are approved for non-ambulatory and bedridden clients. Bedroom 1 approved for ambulatory client only. Age range 60 and over and there is a hospice waiver for 5. The home is a single-story home in a residential neighborhood. The home consists of four (4) bedrooms, two (2) bathrooms, (1) car garage used for storage. The home includes a living, dining, kitchen, and laundry area. The living room has a decorative only fireplace that has a protective metal grill as a front barrier. At 9:55 AM, LPA reviewed four (4) residents files for admission agreements, updated physician reports, and needs and services plan which appeared to be up to date. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings which appeared to be current. At 10:21 AM, LPA conducted a random audit for two (2) residents’ medications that appeared to be dispensed as prescribed by their physician and they were centrally stored and properly locked. There is first aid kit and manual were checked and fully stocked . Continued At 11:00 AM, LPA and Annisa toured the physical plant. There were no bodies of water or obstructions on the premises inside or outside. LPA inspected a total of four (4) bedrooms and two (2) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and there appeared to be sufficient storage for the residents’ personal belongings. The bathrooms appeared to be clean and operational. The water temperature ranged from 105°F to 120. °F, and the facility temperature was 77°F. The kitchen was inspected, and there was a 5-day supply of perishable and a 7day supply of non-perishable food items which was adequately maintained/stored. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. LPA observed that the facility appeared to be clean, sanitary, and appropriately furnished. The fire extinguishers, carbon monoxide detectors and smoke detectors were fully charged and operable. The last Fire/Disaster drills were conducted on 7/1/2025. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to Annisa Wahyu-Support Staff at the conclusion of the visit.