Routine inspection·January 28, 2026

On 01/28/2026, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with care staff Avonett John and explained the purpose of the visit. The Administrator, Doina Savin then arrive approximately 20 minutes later and joined the visit. The Administrator Certificate # is 7002889740 and will expire on 10/20/2027. The current census is 6 with 1 facility staff. This facility is a single story building licensed to serve six (6) non-ambulatory residents with an approved hospice wavier for three (3) residents. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room, garage, and staff office/room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee toured the kitchen and observed sufficient seven-day non-perishable and two-day perishable food supplies. Hot water temperature was measured at 118.1 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. The smoke and carbon monoxide detectors are in compliance with fire safety. The fire extinguisher is located in entry of the hallway and was last serviced on 12/12/2025. The last fire drill was conducted on 12/01/2025. LPA Lee observed the facility has a has a public telephone in the kitchen and the facility has the required posters posted. Facility thermostat was observed at 75 degrees Fahrenheit, which is within the required regulation of 68 to 85 degrees Fahrenheit. CONTINUED LIC 809-C LPA Lee observed toxins and sharp knives located in the kitchen cabinet and kept them locked and inaccessible to residents. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. The first aid kit was checked and contained the required components. LPA Lee audited medications for 3 out of 6 residents by comparing the medications on hand with their Medication Administration Records (MARs) and confirmed that all records were accurate and complete. LPA Lee reviewed 6 out of 6 resident files, and they were complete. LPA Lee reviewed 2 staff files, and it was also complete. LPA Lee reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents were provided to LPA Lee during today’s visit: (1) LIC 308 Designation of Administrative Responsibility (2) Copy of Administrator Certificate (4) LIC 610 Current Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) LIC 500 Current Personnel Report As a result of this annual visit, the facility is in compliance with Title 22 Regulation. An exit interview was conducted with Administrator Savin a copy of these LIC 809 reports was provided to the facility.