Routine inspection·March 12, 2025

Licensing Program Analyst (LPA) Sandra Urena and Quoc Huynh arrived at the facility unannounced to conduct a required annual inspection. The LPAs were greeted by staff and informed them of the reason for the visit. The staff contacted the Administrator to inform them of the visit. The Administrator Jasmin Sargsyan arrived shortly thereafter. The LPA and the Administrator 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. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 2/7/2025. The LPAs observed required postings throughout the common space. KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at 114.1 degrees Fahrenheit. 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 and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. Handwashing signs were posted. The hot water temperature measured in the restrooms at 115.1 degrees Fahrenheit. Continues on LIC 809C... OUTDOOR AREA: The backyard has a shaded area with outdoor furniture No bodies of water noted. The washer and dryer are in a room adjacent to the kitchen. All cleaning liquids and materials are locked in a cabinet above the washer and dryer. RECORDS: Records review began at 11:30 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 12:41p.m. Medications are centrally stored and locked in the medication room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. 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 - Certificate of Liability - Emergency Drills No citations were issued. Exit interview conducted. A copy of the report was issued.