Routine inspection·April 13, 2023

Licensing Program Analysts (LPAs) Angel Ascencio and Zabel Chochain arrived at the facility unannounced to conduct a required Annual visit. The LPAs met with Administrator Vishtasb Kykhosrowpour and Farnaz Servati and explained the reason for the visit. The LPA toured the physical plant areas inside and outside, with Vishtasb Kykhosrowpour at 9:15 a.m., to ensure there are no health and safety hazards. BEDROOMS: There are (6) six bedrooms designated for resident use. Bedroom #1 has a direct exit to the exterior. The facility is capable of furnishing each room with clean linens, appropriate furnishings, and sufficient lighting for resident use. RESTROOMS: There are (4) four bathrooms designated for resident use. (2) two bathrooms are located inside the resident bedrooms and (2) two are located in the hallway. Bathrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPAs measured the hot water temperature in (2) two out (4) four bathrooms. The hot water temperatures measured between 110.6 and 115.9 degrees Fahrenheit. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be properly stored and locked at time of visit. Hot water was measured and was within regulation. Continued on LIC 809-C COMMON SPACES: The common spaces included the living room; dining area and office area. The LPAs observed cameras in all common spaces and exterior. All areas were clean, sanitary and in good repair. Smoke detectors are hardwired and interconnected, there is a Carbon Monoxide detector installed at the facility. The fire extinguisher was observed to be in compliance within one year. The LPAs observed required postings in the entrance hallway. BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. There is a pool on the property that was observed to be gated and locked at the time of the visit. The LPAs observed a Laundry room which is located inside the attached garage. Laundry detergents, cleaning supplies, pesticides, and/or toxins are also stored in the garage/laundry area. INFECTION CONTROL: During today’s visit, the LPAs spoke with the Administrator Vishtasb Kykhosrowpour regarding the facility’s infection control practices. The LPAs advised the Administrator to maintain a 30-day supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time and the LPAs reviewed facility’s policies and procedures as it pertains to infection control. During today's visit, the following deficiencies were observed and cited under LIC 809 - D: At 9:45 a.m. Full bed rails were observed for three (3) out of 6 residents that were not on hospice. At 9:52 a.m. Ibuprofen and Anti-Itch cream was observed accessible in the common area. At 9:55 a.m. A section of the common living area was set up as a staff sleeping area. At 2:30 p.m. Six (6) out of 6 resident did not have PRN Authorization Forms. Exit interview conducted and a copy of the report and appeal rights were issued to Administrator.