Routine inspection·August 20, 2021

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Executive Director, Irina Sarkisyan and Resident Services Director, Mildred Pascual, both assisted with visit. The facility has a capacity of 90 residents. It is licensed to serve elderly residents age 60 and above, approved for fifty-six (56) non ambulatory residents. The facility has eight (8) Hospice Waiver for on file. Four (4) residents are on hospice. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. The facility is a two-story building and 63 resident rooms. Resident rooms consisted of a bedroom, bathroom and closet. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 105.5 to 113.4 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies. The facility consists of seven (7) office rooms, reception area, beauty salon, med room, library, activity room, dining room, kitchen, two (2) laundry rooms, two (2) housekeeping storage rooms, staff lounge, and courtyard. Four (4) public restrooms are available which are clean and operational. Sufficient supply of perishable and nonperishable foods. Smoke detectors and carbon monoxide detectors are operable. (-continued in LIC 809 C-) Smoke detectors in the hallway and common areas are hard wired. They are monitored by a fire alarm company. The facility has total of ten (10) fire extinguishers. They are fully charged and last service was on December 20, 2020. F irst aid kit is fully stocked with a manual. All mandated documents and signages are posted in common areas. The outdoor activity area is free of visible hazards and debris. There is shaded patio and garden areas with ample seating. Medications are centrally stored and locked. Resident records inspected are current. Fire/ Emergency drill conducted on 7/26/2021. LPA checked the signal systems in resident rooms and found system to be operable and staff responded to resident rooms within five minutes. No deficiencies cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to facility Administrator, whose signature on this form confirm receipt of these documents.