The facility has five (5) bedrooms and two (2) bathrooms designated for residents. One (1) bedroom is designated for staff/office only and will remain locked at all times. Facility is surrounded by a 5 ft tall gate. LPA entered facility through an accessible side gate. The facility also has an approved hospice waiver for six (6) residents. The Annual Licensing fees are current. At the time of visit there was three (3) staff and five (5) residents present. Facility is following a mitigation plan.

At 11:35 am, with the assistance of (S1) Administrator Armenuhi Davtyan, LPA took a tour of the physical plant.

Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected. There are carbon monoxide detectors that function properly. The fire extinguisher is located in entryway near kitchen. LPA observed a second extinguisher in staff office. The charge date is 12/14/23.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked cabinet in the kitchen.

Properly labeled medications were locked and secured in an over he counter cabinet inaccessible to residents. All MARS data signed and dated.

Laundry room Located in the staff office. Both machines were in good condition and operational. Cleaning products were stored next to the machines in a tall off white cabinet locked.

Bedrooms: There were five (5) bedrooms designated for residents' use. Two (2) rooms will be shared, and two (2) rooms were private at the time of the visit. LPA observed rooms to have bedding sheets, pillowcase, blankets, mattress pads, which are in good condition. There is at least one chair, a night stand, and sufficient lighting for each client. The mattresses and bedsprings were also checked for condition. Window covering and window screens are in good repair for each room.

Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 114 degrees Fahrenheit. Cleaning supplies are being stored in the hallway in a tall off- white cabinet.

Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit.

Outside grounds were toured and no bodies of water were observed. Patio furniture under a shaded area was accessible to clients. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

At 01:00 PM LPA conducted a file review.

5 staff records were reviewed, 5 out of 5 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions.

5 resident records were reviewed and, 5 out of 5 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans.

No deficiencies cited.

An exit interview was conducted, A copy of this report and appeal rights were discussed and left with Administrator Armenuhi Davtyan.