Routine inspection·August 11, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:12 AM. LPA met with facility staff who contacted the facility Administrator Zaruhi Harutyunyan. The Administrator arrived to the facility at 10:33 AM Entrance interview conducted and the reason for the visit was explained. Beginning at 10:33 AM LPA along with the facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured cabinet contain knives and other sharp objects. LPA observed a secured under-sink cabinet to contain cleaning chemicals that were locked and inaccessible to clients in care. BEDROOMS: There are three (3) bedrooms in the facility; all are designated for resident use, and all are designated as dual occupancy rooms. LPA and facility Administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom number one (1) is the approved bedridden room and contains a direct exit to the outside of the facility. Auditory alarms were observed to be functional on all exits. Continued on LIC 809C. BATHROOMS: There are two (2) bathrooms at the facility. One (1) is designated as a resident restroom and one (1) is designated as a staff restroom. Both restrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in the resident shower and by the resident toilet, all were properly secured. The water temperature was measured between 109.8 and 112.0 degrees Fahrenheit, which is in compliance with regulation. COMMON AREAS: This includes the living room and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room was observed to contain secured filing cabinets which contained facility files and resident medications, a television, and activities for resident use. LPA observed adequate seating for resident use. The hallway was observed to be clean and free from any obstructions. Required postings were observed throughout the facility. LPA observed a wall mounted fire extinguisher to be fully charged and purchased on 05/10/2025. Smoke detectors and carbon monoxide detectors were tested at 11:20 AM and were functional at the time of the visit. OUTDOOR SPACE: The facility has one (1) emergency exit gate located at the front of the facility. LPA observed clear passageways for emergency exit use. The facility has adequate shaded outdoor seating for resident use. Cameras were observed on the outdoors of the facility. Five (5) sheds were observed to be properly secured. The sheds were observed to contain a washer and dryer, cleaning products, an adequate supply of emergency food and water, cleaning chemicals, and additional care supplies. RECORD REVIEW: Record review began at 11:15 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed. All resident files reviewed contained all required documentation. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 12:05 PM. Medications for three (3) residents were observed. All medications reviewed were documented properly on their respective centrally stored medication and destruction record sheet. No deficiencies were observed during medication review. Continued on LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. The facility’s emergency disaster plan is up to date and is adequate. Both the facility’s emergency disaster plan and infection control plan are updated annually by the facility’s Administrator. The facility’s last emergency disaster drill was conducted on 06/26/2025. INTERVIEWS: LPA interviewed one (1) staff and two (2) residents. All residents interviewed stated that facility staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. The staff member interviewed was knowledgeable on their roles and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s updated LIC 500, resident roster, and liability insurance. No deficiencies were observed during today’s visit. Exit interview conducted. And a copy of the report was provided.