Facility Evaluation Report

On 10/28/25 at 3:30 PM, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Singh met with a staff and was granted entry to the facility. At the time of the visit there were one (1) staff present, and four(4) residents present. Licensee/Administrator Shaden Hussein arrived during the visit. LPA Singh explained the purpose of the visit to Licensee/Administrator Shaden Hussein.

The facility is a four (4) bedroom, two (2) bathroom home with a kitchen/dining area, living room, laundry area and garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) residents of which six (6) are ambulatory residents. The facility has two (2) Hospice Waiver. The current census is four (4) residents. LPA Singh was accompanied by Licensee/Administrator Shaden Hussein to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant : The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA observed no obstructions to indoor passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, and storage space, lamps and chairs and sufficient lighting in the bedrooms.

Moreover, LPA observed that bathrooms were clean, and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms.