Routine inspection·September 4, 2025

On September 4, 2025, at 9:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Adriana Abrudan and explained the purpose of the visit. The facility is licensed to operate for six (6) non-ambulatory and have a hospice waiver for three (3) residents. The facility is a single-story building located in a residential neighborhood. It consists of the following: six (6) resident bedrooms, one (1) staff bedroom, five (5) bathrooms, family area, dining area, kitchen, one shed in the backyard, attached 3-car garage, and an outside covered patio area LPA Kim toured indoor and outdoor of the physical plant with ADMIN Abrudan. There are no obstructions or bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. All bedrooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, Resident Room 4, Resident Room 5, and Resident Room 6. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 112.6 degrees F and 116.6 degrees F. A comfortable temperature of 76 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable food and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. The facility has one (1) fire extinguisher that is charged and mounted in the kitchen, with inspection date of August 20, 2025. All smoke/carbon monoxide detectors were operable. A working telephone remains available. First Aid Kit contained all the necessary elements. Evidence of Liability insurance for the facility is effective October, 11, 2024, and will expire on October 11, 2025. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The facility conducts Fire/Safety Drills quarterly and was last conducted on August 8, 2025. LPA conducted an audit of resident files (R1-R6), staff files (S1-S3) and medication and medication administration record that were all in order and complete. LPA Kim conducted interviews for 2 staff and 2 residents. No deficiencies were cited this visit. An exit interview was conducted, and a copy of this report was provided to Administrator Adriana Abrudan.