Routine inspection·September 22, 2025

On September 22, 2025, Licensing Program Analysts (LPA’s) Jenifer Tirre and Eboni Bentley conducted an unannounced required visit using the CARE Inspection Tool. LPA’s were greeted by staff and granted entry after stating the purpose of the visit. Director of Health Services Putri Tarigan helped assisted with today’s visit. Executive Director Dan Kashani arrived shortly after and assisted with the facility inspection. The facility is licensed for Sixty six (66) non-ambulatory residents of which eight (8) may be bed ridden with approved hospice waiver for fifteen (15) residents. Currently, there are three (3) Hospice residents present during today’s visit. Facility is a two story building with 58 resident rooms (combined private and shared). Facility has Assisted Living and Memory Care located on both floors. Facility has activities room, Bistro, ice cream parlor, salon parlor, dining rooms located on both levels as well as enclosed outside patios with delayed egress gates. At around 8:50AM, LPA’s conducted a tour of the physical plant accompanied by Director of Health Services Putri Tarigan, and the following was observed: There were no bodies of water on the premises. Resident rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. During visit water temperature inside resident bathrooms and kitchen sinks were tested operational with water temperatures measured between 112.8 to 117.3 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA’s observed the facility to be furnished at the time of the visit. Storage areas for toxins, cleaning supplies and sharps objects were stored and not accessible to residents. CONTINUED 809C The kitchen was inspected, facility has sufficient two day perishables and seven day non-perishable foods. Facility had supply of emergency food and water. LPA’s observed facility had emergency food kits with servings varying from 12 to 93 per kit. LPA’s observed eight fire extinguishers which were fully charged and mounted. LPA’s reviewed facility has three Evacuation chairs posted on second floor stairwells. A review of the Medication Records Administration (MAR) was conducted, and LPA observed six of six records are in compliance. During the visit, LPA observed the facility's infection control practices. LPA’s observed sanitizing stations in common areas and restrooms. LPA’s observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Facility mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on September 18, 2025. Based on in house documentation from Direct Supply Tels and Champion Fire Solutions Inc facility had operational smoke and carbon monoxide detectors tested and passed on July 10, 2025. The facility has current liability insurance on file effective 7/1/2025 – 7/1/2026. A review of six residents (R1-R6) service files and six staff (S1-S6) personnel files revealed to be complete. The facility has the current administrator's certification on file for Faraz Kashani # 7030587740 - Expiration 5/1/2027. No deficiencies during this inspection visit. An exit interview was conducted with Executive Director Dan Kashani, and a copy of the report was provided.