Routine inspection·October 22, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with and explained the reason for the visit. The facility is licensed to served 6 residents, 60 years and over; of which 5 may be non-ambulatory and 1 bedridden with a hospice waiver for (6). Facility consist of a living room, a dining room, a kitchen, 4 resident bedrooms, 2 bathrooms, a laundry area, a backyard, and a garage. LPA conducted a tour of the facility with Gohar Armani and observed the following: Facility is clean and in good repair inside and outside. All ramps and passageway are clear of debris. Living room and dining room are properly furnish and required posting was observed. Kitchen was observed clean, and sufficient food supplies were observed for at least 2 days of perishables and 7 days of non-perishables. All cleaning supplies,medications, and sharps were observed locked in cabinets in kitchen/dining area. Laundry area was observed without hazardous. Each resident bedroom was observed with sufficient lighting, the required furniture and bedding supplies. Each bathroom was observed clean, with grab bars and skid mats. Water temperature was tested between 112.3 -116.8 degrees F., which is within the required 105-120 degrees F. Backyard has a covered patio with furniture. Carbon Monoxide/Smoke detectors were tested. Fire extinguisher was observed. LPA reviewed files for 5 residents and 5 staff. Administrator certificate #6043240740 was observed exp. date: 3/15/25. Interviews were conducted with 2 staff. Residents were not interview due to cognitive skills. Infection Control Plan and Emergency Disaster Plan were reviewed. Facility conducted a fire drill on 8/20/24 and are conducted quarterly. No Deficiencies were noted during this visit. Exit interview was conducted and a copy of this report was provided.