Routine inspection·October 28, 2025

On 10/28/25 at 3:30 PM, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Singh met with a staff and was granted entry to the facility. At the time of the visit there were one (1) staff present, and four(4) residents present. Licensee/Administrator Shaden Hussein arrived during the visit. LPA Singh explained the purpose of the visit to Licensee/Administrator Shaden Hussein. The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry area and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) are ambulatory residents. The facility has two (2) Hospice Waiver. The current census is four (4) residents. LPA Singh was accompanied by Licensee/Administrator Shaden Hussein to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA observed no obstructions to indoor passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps and chairs and sufficient lighting in the bedrooms. Moreover, LPA observed that bathrooms were clean, and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms. LPA observed night light maintained in hallways and passages to non-private bathrooms. LPA observed the outdoor passageways free of obstructions. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperature in the resident bathroom to be at 116 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. Cleaning supplies and sharps were kept inaccessible to residents in care There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the medication cabinet. Food Service : Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Emergency food and water supply was stored Care & Supervision : LPA observed sufficient number of staff to provide care and supervision to the residents in care and staff scheduled to work at night as required for facility with dementia residents. Completed Emergency Kit and first aid manual observed at the facility. Record Review : LPA reviewed three (3) resident files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with tuberculosis (TB) test results. Staff#2 did not have TB Test and current CPR/first aid on file, deficiency will be issued. In addition, Facility does not have emergency/ disaster/fire drill conducted quarterly on file. deficiency will be issued. Liability Insurance valid through 12/19/2024-12/19/2025. LPA Singh reviewed medications administration records(MAR). LPA observed activity program for the residents at the facility. An exit interview was conducted where this report, LIC809, LIC809C were discussed and provided to Licensee/Administrator Shaden Hussein.