Routine inspection·October 30, 2025

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to caregivers Marlene Hernandez and Edessa Dietsch. House Manager Dearme Doverte arrived later during the visit. The facility's license shows a maximum capacity of six (6) residents, all of which may be non-ambulatory. Additionally, the facility is approved for four (4) hospice waivers. During today’s inspection there were six (6) residents in care. LPA and House Manager Doverte toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Common bathroom sink was 112.2F and bathroom sink in shared resident room bathroom read at 112.4F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to residents in care. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients; chemical items were in a locked cabinet in the locked garage area.  Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per House Manager Doverte, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months, dated for September 2025. Last emergency drill conducted on 9/11/25 for the topic of fire. First aid kit was complete and readily accessible, aside from a first aid manual. A technical Violation (TV) was issued and consultation by LPA provided. Required licensing postings were observed in visible areas of the facility, but LPA did note that publically posted resident rights were not present. Resident records did contain a signed copy. An additional TV was issued. LPA interviewed two (2) staff and two (2) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. LPA observed staff utilize personal protective equipment when assisting residents. LPA also observed residents being attended to timely and treated with respect. No deficiencies were cited during the inspection. An exit interview was conducted with House Manager Doverte to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.