Routine inspection·October 10, 2025

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry by staff and explained the reason for the visit. The facility is a single story home with four bedrooms, two and a half bathrooms, a sun room and a detached garage with an approved fire clearance of six non-ambulatory residents, of which one may be bedridden, and an approved hospice waiver for three. The facility currently has a census of five residents in care and one resident on hospice. During today’s visit, LPA and Administrator Saba Tesfay toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in 3 out of 3 bathrooms and kitchen sink. The hot water temperature measured 97.3, 104.3 and 106.8 degrees Fahrenheit in bathrooms and 102.2 degrees Fahrenheit in the kitchen and all smoke detectors were operational. Facility does not have documentation emergency drills are conducted quarterly for 2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand.LPA observed emergency food and water in the garage and pantry. LPA observed cobwebs in the following areas, hallway cabinet where linens are stored, laundry area in behind washer/dryer and in kitchen cabinet on left hand of stove. LPA did not observe an oxygen sign for a resident that is using an oxygen tank. LPA observed unsecured insulin injections in facility fridge, staff stated residents do not self administer injections. LPA observed Resident 1 (R1) in a non-ambulatory room when they are listed as bedridden per physician's report. LPA reviewed two of two staff training and fingerprint records and conducted a complete review of five out of five resident records. LPA confirmed that administrator Saba has a current administrator certificate which expires on May 30th, 2027. LPA Mendivil consulted with Administrator Saba regarding reporting requirements and the importance of documentation. Based on observations made deficiencies are being cited. An exit interview was conducted and a copy of this report was provided.