Beginning at 10:28 AM, the LPA, along with S1 toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects.

BATHROOMS: There are three (3) bathrooms at the facility. Two (2) are designated as common resident bathrooms and one (1) is designated as a staff bathroom. All bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. The water temperature was measured in all bathrooms between 107.6 degrees Fahrenheit and 112.3 degrees Fahrenheit which is in compliance with regulation.

Continued on LIC 809C.

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

COMMON AREAS: This included the living room, dining room, storage room, and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. LPA observed the living room to contain a couch, television, an appropriately screened fireplace, and activities for resident use. The dining room was observed to be clean and contained adequate seating for resident use. LPA observed the dining room to contain a wall mounted fire extinguisher that was fully charged and was last serviced on 05/19/2025. The hallway was observed to contain two (2) properly secured closets and one (1) unsecured closet. One (1) secured closet contained resident files and medications. One (1) secured closet contained the facility’s cleaning supplies and an additional freezer. The unsecured closet contained the facility’s washer and dryer and adequate emergency food and water supplies. The storage room was observed to contain a pool table, lounge chair, and miscellaneous decorations. Smoke detectors and carbon monoxide detectors were tested at 11:03 AM and were functional at the time of the visit.

OUTDOOR SPACE: The facility has one (1) emergency exit gate, LPA observed clear passageways for emergency exit use. The facility had adequate shaded outdoor seating for resident use. LPA observed three (3) appropriately secured sheds to contain tools, chemicals, paints, and other household supplies.

RECORD REVIEW: Record review began at 11:10 AM. Staff and client records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, client physician's report, needs and service appraisal, consent forms, and personal rights. Six (6) staff files were reviewed. All staff files contained the required documents and trainings. Four (4) client files were reviewed. All client files contained all required documentation and signatures. No deficiencies were observed during record review.

Continued on LIC 809C.

INFECTION CONTROL / EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. The last emergency disaster drill was conducted 09/05/2025. The facility’s emergency disaster plan and infection control plan are reviewed/updated by the facility Administrator annually.

INTERVIEWS: LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on their role and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. LPA interviewed two (2) clients. Both clients interviewed stated that the staff treat them well. No clients interviewed had any concerns with the facility.

During today’s visit LPA obtained a copy of the facility’s updated LIC500, resident roster, surety bond, and liability insurance.

No deficiencies were observed during today’s inspection. Facility Administrator Rafael Matevosian was unable to sign this report but has designated S1 to sign on their behalf. This report was read to the Administrator via telephone call. Exit interview conducted and copy of the report was issued.