Primrose 2

Type of visit: Required - 1 Year

At 9:45am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an unannounced required annual visit. LPA met with staff, later Administrator Nino Smith arrived and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility is a single-story building with 7 bedrooms, 3 bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (6) residents, of which 6 may be non-ambulatory, of which all 6 residents can be bedridden. The facility serves residents with dementia. Approved hospice waivers for 6 residents. Kitchen: At approximately 10:50am, LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. Kitchen surfaces were sanitary, and all appliances were functional. Sharps were locked below the counter, and cleaning solutions were locked in separate cabinet in the kitchen. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 9/9/2025. Medications: At approximately 12:45pm, LPA observed medications are centrally stored and locked inside the kitchen cabinet. LPA also observed an additional locked cabinet where resident and staff files are kept. Bedrooms: LPA observed total of seven (7) bedrooms of which six (6) are designated for residents’ use. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has awake staff. Bathrooms: LPA observed five (5) bathrooms, and all bathrooms appeared to be clean and in good repair. Properly supplied with toilet paper, soap and paper towels. LPA observed appropriate grab bar and all bathrooms had non-skid mats. LPA observed appropriate hand-washing signs posted in each bathroom. At 11:15am, hot water temperature measured at 107.4°F. Continue on LIC809-C Common Areas: The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, and comfortable furniture. No obstructions or tripping hazards throughout the facility. LPA observed an operable washer and dryer placed inside the locked garage. All detergents were also stored and locked. Extra emergency food and water was also readily available for residents in care. Smoke detectors/carbon monoxide. At 12:55pm, LPA tested the dual-function smoke and carbon monoxide detector to be operational. When tested, 3 out of 3 detectors functioned simultaneously, and the fire door closed. Outside areas: At approximately 11:35am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is no bodies of water or swimming pool at the facility. All emergency exit paths were free from obstructions. Exit gates were unlocked. Between 11:00am to 12:45pm, LPA reviewed records of six (6) residents and four (4) staff. Resident and staff records appeared to be complete and updated. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. Facility also maintains Medical Administration Records (MAR). LPA observed centrally stored medication, and First Aid kit locked in the commercial cabinet and inaccessible to clients in care. LPA observed First-aid kit is complete and has new manual. PRN medications have written orders from a physician. During CSMDR / MAR / Medication review, LPA conducted medication count and noted Resident #4’s (R4) medication quantities on hand did not match the amounts listed on the CSMDR order. Potentially dangerous items are kept inaccessible to residents in care. Facility operates with two (2) shifts and has two (2) staff members for each shift. An emergency exit plan/sketch is posted on the wall along with other posting requirements. LPA interviewed the Administrator and two (2) Caregivers, one (1) resident who agreed to answer questions. LPA collected LIC500, LIC9020, Certificate of Liability Insurance. The Administrator's certificate - Exp date is 12/5/2026. Citation issued during today's visit, see LIC809-D. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 12, 2026

Type of visit: Required - 1 Year

On 3/3/2025 at 9:30am Licensing Program Analyst (LPA) Perchui Milena Khurshudyan arrived at this facility to conduct a required Annual Inspection. Upon arrival LPA was greeted by the Caregiver John Enriquez who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. LPA Khurshudyan reviewed the required postings on a wall next to the entrance area. The Administrator arrived shortly after. The inspection tool was used to complete the visit. At 10:25am. LPA with the help of the caregiver began a physical plant tour of the facility and the following was observed: This is a single-story building with seven (7) bedrooms, of which 6 bedrooms are designated for residents’ private use and one bedroom designated for staff use only. There are five (5) bathrooms, kitchen, common areas: living and dining rooms, and outdoor areas. It has an approved fire clearance for six (6) Non-ambulatory residents, of which six (6) may be Bedridden. Facility also has Hospice waiver for six (6) residents. Common Areas: The facility maintains a comfortable temperature at 70°F. The living room and dining area appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility was observed. Kitchen: At approximately 10:40am LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. LPA observed that cabinets containing chemicals were not locked and accessible to residents, sharps/knives and centrally stored medications were properly stored and locked inside the kitchen cabinet. There is a fire extinguisher on the kitchen wall which was last serviced on 08/12/2024. Bedrooms: There are seven (7) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Facility has awake staff. Continue on LIC809-C Bathrooms: At 10:50am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 115.8°F. LPA observed appropriate grab bar and non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 11:05am they were tested and observed to be operational. Outside areas: At approximately, 11:20am LPA toured the outside area of the facility and observed appropriate outdoor furniture, with a covered shaded area for residents LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Laundry Room: Laundry machines are in a separate locked area outside of the facility. Disinfectants, laundry detergents and hygiene supplies were stored and inaccessible to residents in care. Garage: The garage is currently being used as an office space and storage. Between 11:45am to 12:40pm, LPA reviewed records of six (6) residents and four (4) staff members. Resident and staff records appeared to be complete and updated. MEDICATION: LPA observed centrally stored medication and First Aid kit locked in the kitchen cabinet and inaccessible to residents in care. LPA observed First-aid kit is complete and has new manual. Facility has Dementia Care Program. PRN medications have written orders from a physician. The facility serves residents with dementia and facility has trained staff to meet the needs of residents who are diagnosed with dementia. Facility has two (2) staff for AM shift and two (2) awake caregiver for PM shift. Administrative: Annual fee is current. All required signs are posted. LPA collected LIC500, LIC9020 and Certificate of Liability Insurance. The Administrator Certificate got renewed however still pending. One citation issued during this visit, please see LIC809-D. Exit interview conducted. Copy of report signed and delivered to the Licensee/Administrator.the state’s words, verbatim · CDSS document, Mar 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with administrator, Mubeen Naimuddin, for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 8:15 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of six (06) bedrooms and five (05) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying six (06) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for laundry and storage. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 72°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located in the kitchen near the side exit, observed to be full and last inspected on 09/27/2023. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 112.6°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Mar 16, 2024