Routine inspection·April 9, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:32 AM. LPA met with facility staff who contacted facility Administrator Rebeka Durgaryan via telephone call. The facility Administrator arrived to the facility at 09:52 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:53 AM, the LPA, along with 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: COMMON AREAS : This includes the living room, dining room, and hallways. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains a couch, a television, an office area for the Administrator, a locked storage cabinet containing resident medication, and activities for resident use. The dining room was observed to be clean and contained adequate amounts of seating for resident use. LPA observed all required postings for the facility located on the living room wall. Fire extinguishers were observed throughout the facility, and all were fully charged and purchased on 02/11/2025. Fire alarms, fire doors, and carbon monoxide alarms were tested at 12:06 PM and functioned properly at the time of inspection. LPA observed cameras throughout the common areas of the facility. The Administrator confirmed that the cameras are not active and do not record audio. Continued on LIC 809C. BEDROOMS : There are five (5) bedrooms in the facility; one (1) is a single occupancy room, two (2) are dual occupancy rooms, one (1) is a staff bedroom, and one (1) bedroom is unoccupied. LPA and facility Administrator toured all five (5) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on all facility exits and all were functioning at the time of inspection. The staff bedroom was observed to contain the facility’s emergency food and water supplies and was properly secured and inaccessible to clients in care. BATHROOMS : There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared resident bathrooms and one (1) is designated as a private resident bathroom. All bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Two (2) bathrooms were observed to contain secured cabinets that contained cleaning supplies and grooming supplies. Grab bars were observed in all showers and near all toilets, all were properly secured. The water temperature was measured between 108.9 and 117.3 degrees Fahrenheit, which is within the range required by regulation. KITCHEN/LAUNDRY : The LPA observed the kitchen area to be clean. Kitchen appliances were 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 lock box to contain knives. LPA observed the laundry to be located adjacent to the kitchen. LPA observed secured cabinets in the laundry to contain detergents and extra cleaning supplies. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the back yard. All railings located at the facility were secured properly. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:33 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, first aid certification, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documentation and trainings. Five (5) resident files were reviewed. One (1) resident was identified by their physician to be a bedridden resident. LPA spoke with the resident who confirmed that they were unable to reposition without staff assistance. LPA confirmed that the facility’s fire clearance does not permit them to admit bedridden residents. LPA informed the Administrator that admitting bedridden clients is a violation of their fire clearance and poses an immediate safety risk to clients in care. LPA informed the Administrator that this is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (04/09/2025). The Administrator expressed understanding and confirmed that the resident would be relocated to a licensed facility that has an appropriate fire clearance to care for bedridden residents. MEDICATION REVIEW: Medication review began at 12:38 PM. Medications are stored centrally and securely in a cabinet in the living room. Medications for three (3) residents were observed. All medications observed were documented appropriately on their centrally stored medication and destruction record sheets and their Medication Administration Record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/30/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan were reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed one (1) staff and three (3) residents. All residents interviewed stated that the 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 role and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. Continued on LIC 809C. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency and civil penalty were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.