Routine inspection·August 20, 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 Co-Administrator Jennifer Fernandez. The facility's license shows a maximum capacity of six (6) residents, one (1) of which may be bedridden. Bedridden may only reside in bedroom #2. Additionally the facility is approved for 2 hospice waivers. During today’s inspection there were zero (0) residents in care. Per Co-Administer Fernandez, the facility has not had any residents since the end of March 2025, however the plan is to eventually have the facility operating with residents in the future. LPA and Co-Administrator Fernandez 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. No furniture was present in the facility however as floors were being redone. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at accessible taps were all compliant: kitchen sink was 110.4F. 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. As the facility currently has no residents, no perishable or non-perishable foods were present. Cooking, dining equipment, and utensils were present. Knives were locked and inaccessible to potential/future residents. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients.  As there are no residents currently, no medications were being kept in the premises, however, Co-Administrator Fernandez showed LPA where medications were stored when residents were present. No pools or bodies of water exist on the premises. Per Co-Administrator Fernandez, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were present but maintained in storage. First aid kit was complete and readily accessible. Required licensing postings were observed in storage for the time being. LPA interviewed one (1) staff and zero (0) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility administrative records, but no staff or resident files as the facility is not accepting residents currently. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Co-Administrator Fernandez to whom a copy of this report was provided. Their signature below confirms receipt of this document.