Routine inspection·November 13, 2023

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection visit using the complete CARE Inspection Tool and was let into the home by staff. Erna Gevorgyan, Designated Staff, was contacted via telephone and she arrived at the facility to conduct the visit at 10:52am to conduct the visit. Hovhannes Ispiryan, Administrator is out of town. The facility is a single storey family home consisting of a living room, a dining room, a kitchen, 4 bedrooms, 2 private bathrooms and a common bathroom. The facility is fire cleared for 1 AMBULATORY, 4 NON-AMBULATORY and 1 BEDRIDDEN resident. Located at the back of the facility is a alternate dwelling unit(ADU) that was recently added. Permits were obtained on 3/23/22 and the ADU was approved for occupancy on 6/30/23. Copies of the permits were obtained today and a copy of the Certificate of Occupancy will be provided to the Department as soon as the Licensee receives a copy. The address assigned to the ADU is 6509 Bonner Avenue and is currently occupied by the Licensee and his family. Due to time constraints, the following domains were reviewed on today's visit: Infection Control, Operational Requirements, Staffing, Personnel Records: Training, Resident Records: Incident Reports, Resident Rights: Information, Planned Activities, Food Service, Incidental Medical and Dental, Disaster Preparedness, Residents with Special Health Needs. The Physical Plant and Environmental Safety Domain will be completed on a return visit. During today visit, all the following files were reviewed: 6 staff files, 4 resident files, Infection Control Plan, Emergency Disaster Plan and the Plan of Operations. Continued on LIC809-C Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Any citations not issued on today's visit will be issued on a return visit. Exit interview was conducted, APPEALS RIGHTS, discussed and a copy was given