Routine inspection·October 13, 2025

On 10/13/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required annual visit. LPA was greeted by care staff, Darlene Shepard, and was granted entry into the facility. LPA informed Darlene of the purpose of the visit. LPA conducted a tour of the facility and observed the following during the tour: The facility is a single-story building which consists of (3) three residents bedrooms, (1) one staff bedroom, (2) two bathrooms, living room, dining room, garage, kitchen, and backyard. There is no pool and/or bodies of water. LPA observed the kitchen area to be clean and free of debris. Knives and other sharp items are located in a locked pantry in the kitchen. Centrally stored medication was also observed in the locked pantry inaccessible to residents. The facility maintained (2) two refrigerators which held the required (2) two day supply of perishable foods. LPA observed a (7) seven-day supply of non-perishable foods. Facility maintain emergency food and water supplies in the garage. LPA observed resident bedrooms to have the required bedding, furniture, seating, and functional lighting. Bathrooms were equipped with grab bars and skid resistant mats in the shower area. Indoor/Outdoor passageways were free from obstruction. Emergency disaster drills are conducted quarterly and range from scenarios. The facility operates their own laundry services; washer and dryer were observed to be in good repair and operable. Additional linen and towels are available for residents and appear to be in good repair. LPA observed the hot water temperature to meet requirements at 109.8°F. Per Administrator, Musarrat Khan, there are no firearms or ammunition on the premises. (Continue to LIC809...) (Continuation from LIC809) Facility sketch, residents personal rights, LTCO, and complaint poster are visibly posted on the walls throughout the facility. Facility staff records review include but are not limited to criminal record clearance, health screenings, TB result, First-aid/CPR training, and relevant training's to provide Assistance with Activities of Daily Living (ADL's). Resident records included but not limited to signed admission agreements, pre-admission assessments, physician reports, property and valuables, and needs/service plans. LPA reviewed (3) three out of (5) five residents Medication Administration Records. LPA conducted observations and records review conducted of the medication and medication administrator records, LPA observed multiple discrepancies. Therefore, deficiencies will be cited during today's visit. An exit interview was conducted and a copy of this report along with LIC9099D, LIC811 and appeal rights will be provided to Administrator, Musarrat Khan.