Nh Care

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tihesha Smith made a case management visit in conjunction with complaint #31-AS-2026081809393. LPA Smith observed two (2) staff in the kitchen upon entry into the facility. When LPA Smith asked Staff #2 (S2) their name, the staff indicated no understanding of English. However when the administrator arrived he confirmed that S2 does speak and understand English, although in a limited capacity. LPA Smith inquired about Staff #3 (S3) and the administrator revealed the staff was a volunteer. During interview with the administrator, LPA noticed S3 was no longer in the facility. Interview with the administrator revealed that S3 does not have a criminal clearance. LPA informed the administrator that all staff including volunteers must have a criminal clearance when working in the facility. LPA Smith also requested administrator to remove clutter/storage items from covered patio technical assistance noted Deficiency on 809D and civil penalty issued.the state’s words, verbatim · CDSS document, Aug 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Aug 22, 2026

Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement not met based on LPA observation and interview with administrator who confirmed staff spouse: "Raev Orozmamat was volunteering and clearance has not been completed, which poses a risk to residents in care.the state’s words, verbatim · CDSS document, Aug 21, 2026

Plan of correction: Individual left at time of visit administrator will submit required clearance documents, and Administrator agrees to prohibit the presence of all individuals without documentation of criminal background clearances from working, residing or volunteering in the facility. POC due date:08/22/26

Type of visit: Required - 1 Year

On 6/02/26, 8:30AM Licensing Program Analyst (LPA) Raymond Comer conducted an unannounced annual visit to this facility. LPA met with the Assistant Administrator, Girgor Kosoyan, and reason for the visit was discussed. Facility is licensed as a single-story residence; fire clearance is licensed for six (6) total residents. One (1) resident may be non-ambulatory, and one (1) resident may be bedridden in bedroom# 3. Facility has a total of three (3) bedrooms, and two (2) bathrooms for residents’ use. At 8:45AM, LPA conducted a tour of the physical plant with the Administrator and observed the following: Physical plant: was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other necessary signage are posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 74.0°F. within the required range. Required postings are prominently displayed and observed to be current. Passageways and entrance were clear of obstruction. Disaster drills were last conducted on 3/15/2026. [LIC809C] Continued- Fire detection system: is present in the facility. Smoke detectors and Carbon Monoxide detectors were tested and working as operable at the time of visit. LPA observed one (1) fire extinguisher located in the kitchen area; purchase/service Date: 11/21/2025. Kitchen: At 9:355 AM LPA observed kitchen as clean, equipped with stove, refrigerator, microwave oven, and multiple appliances. LPA observed an adequate supply of perishables and non-perishable food available for residents; food was observed as properly labeled and stored. Facility’s freezer is stocked with frozen foods, including meats and vegetables. Knives and sharps are stored and locked in a kitchen drawer and are inaccessible to residents. Toxins are stored and locked under the kitchen sink. Medications: observed stored in a locked upper kitchen cabinet and inaccessible to residents. Facility has fully stocked first aid kit and manual located in the medication cabinet. Laundry: LPA observed the laundry area located in outdoor storage; appliances were observed to be functional. Laundry soaps, and other cleaning agents are secured in the laundry shed and inaccessible for residents. Linen storage observed maintaining an adequate supply of linens and towels and bed sheets. Garage: There is no garage at the facility. Commons: LPA observed all common areas of the facility. (Living room and dining room area) LPA observed common areas to be clean, organized, properly furnished and in good condition. Dining room table and seating sufficient to accommodate all residents. Bedrooms were observed as clean, with sufficient closet space, lighting, properly furnished with bedding, linens, dressers, at least one chair, and night stand. Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 118.0°F. Within the required range. [LIC809C] Continued- Outdoor (backyard) area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. There are two (2) sheds used for storage were observed as locked, and inaccessible to residents. Outdoor area observed as clean and clear from obstruction. No bodies of water are located on the premises. Resident records: Records were stored in staff office; LPA observed office as locked and inaccessible to residents. A total of five (5) resident files were reviewed for current IPP and/or Needs and Services plans, physician report, admission agreements and other related documentation. No appraisal was found in reviewed records for for R1, R3, R4 and R5. No Tuberculosis read/results tests was found in reviewed records for R1, R2, R3, R4. No Physican's assessment report was found in reviewed file for R2. Deficiency will be cited on LIC 809-D. Staff records: Records were stored in staff office; LPA observed office as locked and inaccessible to residents. A total of three (3) Staff files were reviewed. Criminal record clearances were present, and staff are associated to this facility; Staff records appear to be complete and current. Exit interview was conducted and a copy of this report and deficiency report was provided to the assistant administrator.the state’s words, verbatim · CDSS document, Jun 2, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at 09:45 am. LPA met with staff, and the administrator was contacted and arrived later. LPA conducted a tour of the physical plant at approximately to ensure there are no health and safety hazards, and the facility is following Title 22 Regulations. Common areas—including the combined living and dining room, as well as the kitchen were evaluated for their ability to safely meet residents' needs. These spaces were inspected for cleanliness, and furniture was assessed for functionality and condition. All common areas were found to be clean, sanitary, and furnished with seating sufficient to accommodate residents comfortably. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the four (4) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with frozen foods to include meats and vegetables. There are two (2) extra refrigerator/Freezers (one in back yard storage/one in front yard storage) both stocked with back stock foods. Resident medications are stored in the upper kitchen cabinet. Medications observed to be locked and inaccessible to residents in care. The sharps are stored in a locked kitchen drawer and inaccessible to residents. Toxins are stored and locked under the kitchen sink. Outdoor laundry area appliances were observed to be functional.One (1) fire extinguisher attached to the wall in the kitchen observed to be charged. (Cont. from 9099) The facility has a total of three (3) bedrooms for residents and two (2) bathrooms for residents’ use. The residents’ bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of hygiene and incontinence supply in hallway closets. Each bathroom has the following items available: hand soap, paper towels, and trash cans. The hot water temperature set for the bathrooms and facility at 120.0 degrees Backyard: Patio furniture observed to be in good repair. There are two (2) sheds used for storage and extra food replenishment. Garage: no garage at the facility. Smoke detectors and Carbon Monoxide detectors were tested and operable at the time of visit. Facility grounds were free of hazards. There is no body of water in the facility. At approximately 10:55 am, LPA reviewed facility records. The Administrator has a current license to include CPR/First aid. Resident records have admissions agreements, Pre appraisal and physician reports. At the time of the visit staff did not have first aid/CPR. The administrator was informed that at least one (1) staff at facility must have a valid CPR/First aid certificate/item corrected later same day. Citation issued on 809D. Exit Interview Conducted / A Copy of the Report giventhe state’s words, verbatim · CDSS document, Aug 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at 12:00 pm. LPA contacted the administrator for point of entry. The administrator was present at the facility and came to the front gate. LPA conducted a tour of the physical plant at approximately to ensure there are no health and safety hazards and facility is following Title 22 Regulations. Common areas were observed for the ability to safely serve the needs of residents. These included the kitchen and living room/dining area combination. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately with adequate seating for residents. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed. There is sufficient for the three (3) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked cabinet in kitchen island. The resident medications are stored in locked upper cabinet in the kitchen. The medication and sharps were observed to be locked and inaccessible to residents. The first aid kit is stored in hall closet #1/pantry. Laundry room is located outside in shed. The appliances observed new, clean, and functional. Toxins under kitchen sink and observed to be locked and inaccessible to residents. There is one (1) fire extinguisher: attached to the kitchen wall observed to be charged. (Cont. from 9099) The facility has a total of three (3) bedrooms for residents and two (2) bathrooms for residents’ use. The resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens in hallway closet #3. Each bathroom has the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the two (2) bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 115.2 and 115.9 degrees Fahrenheit. The backyard has the following: Gazebo, with table and sufficient seating for the residents. Patio furniture observed to be in good repair. There are two (2) sheds used for storage and extra food replenishment. Garage: no garage at the facility. Smoke detectors and Carbon Monoxide detectors were tested and operable at time of visit. Facility grounds were free of hazards. There is no body of water in the facility. There were no immediate health and safety hazard observed during the day of inspection. Yard growth being used for mulch/active work noted. At approximately 1:05 pm, LPA reviewed facility records. Current insurance policy on file. Administrator has current license to include CPR/First aid. Resident records have admissions agreements, Pre appraisal and physician reports. No citations issued. Exit Interview Conducted / A Copy of the Report given.the state’s words, verbatim · CDSS document, May 19, 2024