Routine inspection·November 18, 2025

Licensing Program Analyst (LPA) LaVette Farlow arrived unannounced to conduct the required annual visit to the facility. LPA were greeted and granted access into the facility by Caregiver, Roselina Mardiana and introduced self and stated purpose of the visit. LPA asked Roselina to informed the Administrator of LPA's arrival. The facility has 4 bedrooms, 1 staff room, 2 bathrooms, kitchen, dining area, family room, living room, laundry area in the garage, attached garage, and backyard. LPA completed a walk through of facility, review of records, and conducted a random audit of the medication. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 76 degrees Fahrenheit. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting. LPA inspected client bathrooms; bathrooms were clean and appliances were found functional. LPA observed that facility has a sufficient supply of hygiene items for residents in care. Water temperatures tested at 112.9 and 118.7 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and charged fire extinguisher. LPA observed poster on display for personal rights, and disaster plans were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secure cabinets, inaccessible to clients. At 10:15 AM LPA was completing a tour of the kitchen and observed in the drawer a pair of scissors and a knife/box cutter. LPA advised caregiver to secure the items. A deficiency cited. There was a designated storage space for client/staff files. Medications and first aid kit were in secure cabinets and inaccessible to clients. There are no firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions. Food Service : LPA observed that the facility has a sufficient supply of perishable and non-perishable items. The facility has sufficient supply of dishes, cups, and utensils were also stored properly. Emergency food and water were observed. Yards/Outside: LPA observed one shaded patio, a side gate with self-latching handle on the left side of the house that leads into the backyard. All outdoor pathways were free of obstructions. LPA observed fruit and vegetables trees in the backyard. Record Review: LPA reviewed Administrator and 2 staff files for First Aid/CPR certification, criminal record clearance, training, health screenings and TB test. LPA reviewed 3 residents files for admissions agreements, pre-admissions appraisals, physician's reports, and care plans. Personnel records and residents file appeared to be complete and in order. One deficiency was cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and Appeals Rights were discussed and copies were provided to Administrator, Gulvarg Maya Kaur.