Routine inspection·September 4, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:35AM. The LPA was greeted by Staff, informed them of the reason for the visit, and staff proceeded to notify the Licensee. The Licensee Angela Krbashyan arrived shortly thereafter. Entrance interview conducted. Beginning at 9:52AM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there were no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: Knives were stored inaccessible in a locked drawer near the sink. Cleaning supplies, medications, and first aid kit were stored inaccessible and locked in cabinets to the right of the kitchen. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food and water within regulation. The LPA observed four (4) non-perishable food cans to be expired between May 2025 and August 2025. The Licensee stated the facility will review and update the non-perishables. Food in the two (2) refrigerators and freezers were observed to be properly stored. The kitchen contained laundry machines that were operational. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. Required postings were in the reception/office area located at the entrance of the facility. The facility maintained a comfortable temperature throughout the visit. Nightlights were observed throughout the facility and a hallway closet contained extra linens. BEDROOMS/RESTROOMS: There were nine (9) total bedrooms: seven (7) private resident rooms, one (1) staff room, and one (1) room utilized as storage. Bedroom #2 had a direct exit to the outside and the facility was approved for six (6) bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There were eight (8) total restrooms: one (1) visitor restroom and seven (7) private resident restrooms. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 115.7 degrees F and 118.6 degrees F, which was within the required range. At this time, the facility was in the process of making adjustments for a facility capacity increase request to twelve (12) residents. OUTDOOR AREA: The surrounding grounds had two (2) shaded patio areas equipped with furniture and a grilling area in good condition for residents and visitor use. There were three (3) remote driveway gates used for emergency exits with two pathways on both sides of the house that lead to both yards/driveways. The side pathways had three (3) self-latching gates. No bodies of water noted, and exits are free of obstructions. The LPA observed three (3) sheds in the backyard that contained general storage of facility supplies. Report Continued on LIC 809-C RECORDS: Record review began at 10:43AM. Resident records were reviewed for, but not limited to care plans, physician reports, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The LPA had a discussion with the Licensee to ensure staff are signing their training records to indicate they have received the required topics and hours. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 09/03/2025. Smoke and carbon monoxide detectors were tested at 10:14AM and were operational at the time of the visit. Fire extinguishers were observed throughout the facility and were last serviced on 04/15/2025. MEDICATIONS: Medication review began at 11:52AM. Medications are centrally stored and kept inaccessible in the kitchen cabinets. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Pursuant to Title 22 CA Code of Regulations, the following deficiency was cited (Refer to LIC 809-D). Exit interview conducted. A copy of the appeal rights and report were reviewed and provided.