Routine inspection·October 21, 2025

On October 21, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee (LI) Ahmad Ali was present and assisted on today's inspection. LPA observed that Ahmad Ali has a valid Administrator certificate which expires on May 4, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents, of which one may be bedridden, and has a hospice waiver for four. The facility is a single story home with five resident bedrooms, one of which is shared, one staff bedroom, three resident bathrooms, two living rooms, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the LI, conducted a tour of the interior portions of the facility. On today's visit, LPA observed five resident in care and two care giving staff present. LPA observed residents to be relaxing in their respective bedrooms and in the backyard. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all five resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in a hallway closet. LPA inspected the three resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 109.5 to 117.1 degrees Fahrenheit. LPA observed the staff bedroom to be free of any hazards. CONTINUED ON LIC809-C LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed fire extinguishers to be mounted on the wall in the kitchen and in one living room. LPA observed fire extinguishers to be charged and serviced as of September 19, 2025. LPA tested the wired smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility did not conduct an emergency disaster drill last quarter and the most recent drill was conducted on April 2, 2025. LPA observed the centrally stored medication to be kept in a locked cabinet by the kitchen. LPA observed the facility has a First Aid Kit stored in the cabinet and it had all the required components. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage and laundry. LPA observed chemicals and toxins to be stored in the garage. LPA also observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the LI, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gate of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises. LPA reviewed all five resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication administration records. LPA reviewed six staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, a deficiency is being cited on the attached LIC809D. An exit interview was conducted with Licensee Ahmad Ali. A copy of the report and Appeal Rights were provided.