Routine inspection·February 8, 2024

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. LPA Urena arrived at 9:50 a.m. Staff greeted the LPA and contacted the facility representative Tina Arutyunyan via telephone. The facility representative arrived shortly thereafter. LPA Urena, and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen knives are stored locked and inaccessible in a kitchen drawer. A seven-day supply of non- perishable foods was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen, laundry, and house cleaning supplies are stored, locked, and located in the laundry room which is adjacent to the kitchen. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 70 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. One fire extinguisher located by the kitchen area was purchased on 09/12/2023. The LPA observed required postings throughout the common space. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are three designated client rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: Bathrooms were clean, shower area was in clean condition with grab bars and a non-skid mat available. Paper towels were available for drying hands. Hand washing signs were displayed, and sufficient amounts of soap and paper products in each restroom. Continues on LIC 809C... OUTDOOR SPACE/GARAGE: Backyard is equipped with furniture in good repair for residents’ use. There were no bodies of water noted. Side gate is unlocked, and passageways were clear of any obstructions. The garage is detached from the main house, and the door was locked at the time of the visit. RECORDS: Records review began at 11:57 a.m.., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, 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. All files were in order. MEDICATIONS: Medications review began at 1:00 p.m. ; medications are centrally stored and locked in a cabinet in the kitchen area; medications are labeled and checked for expiration dates. During the medication review, it was observed that the medications were not properly documented on the centrally stored medications and destruction record (LIC 622) . Five out of five residents' LIC 622 were not filled out correctly, which were missing Start Date (first date of medication assistance), and refills. INFECTION CONTROL : The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. 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 LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Deficiencies were cited at this time. Exit interview conducted. A copy of the report was issued.