Routine inspection·July 23, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:02AM. The LPA met with Staff #1 (S1), explained the reason for the visit, and they notified the Licensee. The Licensee Rebeka Durgaryan arrived at 9:35AM. Entrance interview conducted. Beginning at 9:14AM, the LPA and S1 toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The facility is a single-story residential home. The following was observed: COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The living room had a screened fireplace that was inoperable. Required postings were observed in the living room. Locked file cabinets were observed near the dining table and contained files and medications. The facility maintained a comfortable temperature throughout the visit. There was a laundry room located in the hallway of the rear exit. Laundry machines were observed to be operational and locked cabinets contained detergent and cleaning supplies. BEDROOMS/RESTROOMS: There were three (3) total bedrooms, each with dual occupancy. Bedrooms #1 and #2 had direct exits to the outside, with Bedroom #1 approved for one (1) bedridden resident. Report Continued on LIC 809-C Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in the hallway cabinet. There were two (2) total restrooms in the facility: one (1) private restroom attached to Bedroom #2 that is utilized by Staff and one (1) shared resident restroom located in the hallway. 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. LPA observed an unlocked cabinet in the resident restroom that contained cleaning supplies. The Staff stated they forgot to lock it and was planning on cleaning when the LPA arrived. The Staff immediately secured the cabinet. Hot water was tested in the resident restroom and measured at 149 degrees F which is not within the required range of 105 degrees F and 120 degrees F. KITCHEN: The LPA observed knives stored inaccessible in a locked drawer and the drawer’s front panel was falling off its screws. The Staff stated they did not notice the condition of the drawer. Cleaning supplies were locked under the kitchen sink. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food. Emergency water was not observed and the Licensee stated they did not have any. The Staff and Licensee stated the refrigerator in the Kitchen is broken and a new one will be arriving by 07/25/2025. Food is temporarily stored in the refrigerators and freezers in the rear patio which were observed to be properly stored with labels and dates. OUTDOOR AREA: The rear of the facility had an Additional Dwelling Unit occupied by the Licensee. The LPA observed a fenced off pool, however, the gate was not secured. The gate was left ajar at a 40-degree angle and was observed to have a lock that was not in use. The Licensee stated the Staff must have forgotten to lock the pool gate and proceeded to lock the gate. The pool area had two (2) sheds that contained extra facility supplies and general storage. There was one (1) side gate that led to the front yard and was an emergency exit for Bedroom #2. The pool area was also accessible through the side yard and the Licensee stated they removed the gate that separated the pool area from the side yard as a Plan of Corrections on a prior visit. Report Continued on LIC 809-D Prior citation in regard to securing the pool was not found. The Licensee stated they will re-install the gate. The LPA also observed exposed electrical wires along the side yard’s wall and a hole on the wooden ramp utilized by Bedroom #2. The surrounding rear had one (1) shaded patio area equipped with furniture in good condition for resident and visitor use. The front yard had a driveway with an operated gate as well as a door for everyday use. The opposite side of the property had a driveway used as an emergency exit that also led to the front yard. The LPA observed a brown bed frame in the front yard, obstructing the side exit. The Licensee stated it was a brand-new bed that they were planning to replace for a resident; however, the bed was broken. RECORDS: Record review began at 9:56AM. Resident records were reviewed for, but not limited to care plans, physician's report, 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. Records were in order with Staff training missing 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 reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 04/10/2025. Smoke and carbon monoxide detectors as well as the fire door were tested at 9:47AM. The fire door did not latch when released, and was observed to be stuck inside the mechanism. The Licensee stated that smoke alarms were recently replaced and tested, and they did not have this issue. The Licensee called a technician out to the facility, and fixed the latch. MEDICATIONS: Medication review began at 2:21PM. Medications were centrally stored and kept inaccessible. Medications were observed for three (3) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. Report Continued on LIC 809-C Resident #1 (R1) and Resident #2 (R2) were prescribed PRN (as needed) medications and the Licensee did not have a PRN Authorization Letter on file, or records of when and why the PRN medication was administered. Additionally, interview with S1 and the Licensee revealed that they crush Resident #3’s (R3) medications and put it in R3’s food because R3 has trouble swallowing. The Licensee did not have orders from a physician to crush R3’s medications and stated when R3 was previously on Hospice, that was the orders, but R3 is no longer on Hospice. Three (3) Staff and four (4) residents were interviewed. Pursuant to Title 22 CA Code of Regulations and/or Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D). Exit interview conducted. A copy of the report and appeal rights were reviewed and provided.