Routine inspection·December 23, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:28 AM. LPA met with facility staff who contacted the facility Administrator Dianna Karapetyan. The Administrator arrived to the facility at 09:43 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:45 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: OUTDOOR SPACE: The facility had one (1) emergency exit gate located in the front yard; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed a locked storage shed which contained tools and extra care supplies. The backyard was observed to contain an appropriately fenced pool that was empty of all water at the time of the visit. One (1) extra refrigerator was observed in the backyard of the facility. At 09:49 AM LPA observed an unsecured hand saw in the back yard near the storage shed. LPA informed the Administrator who immediately secured the item in locked storage. BEDROOMS : There are five (5) bedrooms in the facility; one (1) is a dual occupancy room and four (4) are single occupancy rooms. LPA and facility Administrator toured all five (5) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on facility exits and all were functional at the time of the visit. Bedrooms #1 & 2 contain direct exits to the outdoors of the facility. Continued on LIC 809C. BATHROOMS : There are four (4) resident bathrooms at the facility and one (1) staff bathroom. Three (3) bathrooms are designated as private resident bathrooms, one (1) bathroom is designated as a shared resident bathroom. All bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured between 111.9 and 113.7 degrees Fahrenheit, which is within the range required by regulation. KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed a secured under sink cabinet which contained cleaning chemicals. LPA observed a fire extinguisher mounted in the kitchen to be fully charged and serviced on 01/05/2025. COMMON AREAS : This included the living room, hallway, and dining area. LPA observed the dining room to be clean and properly furnished at the time of the visit. The living room was observed to contain activities for resident use including a television. The dining area contained a dining table with adequate seating for resident use. LPA observed a locked hallway closet to contain resident medications and facility files. All furniture throughout the facility was observed to be relatively clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:37 AM and were functional at the time of the visit. LPA observed an ADU on the property that was not present at the last annual visit. On 05/12/2025 Community Care Licensing Division (CCLD) was notified of proposed construction at the facility. On 05/12/2025 LPA requested documentation pertaining to the proposed construction including an updated facility sketch. LPA reviewed documentation submitted to CCLD by the Administrator and did not observe an updated facility sketch. LPA informed the Administrator that an updated sketch was requested by CCLD but was not received. The Administrator agreed to send an updated facility sketch to CCLD. Additionally, LPA informed the Administrator that due to the layout of the newly constructed ADU tenants of the ADU share common outdoor areas with facility residents. LPA informed the Administrator that because tenants of the ADU have access to the facility, any future tenants in the ADU will be required to obtain finger print clearance and have association to the facility. LPA informed the Administrator that failure to comply could result in the issuance of civil penalties. The Administrator expressed understanding and agreed to comply with the requirements. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:50 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. Five (5) staff files were reviewed. Staff #1 (S1) was observed to be hired on 12/15/2025. During the visit LPA observed S1 to be providing assistance to residents with activities of daily living (ADLs). LPA reviewed S1’s file and did not observe trainings on file. LPA asked the Administrator why trainings were not in S1’s file and the Administrator informed LPA that some trainings had been completed but since S1 was new no documentation had been created. LPA informed the Administrator that staff members shall complete twenty (20) hours of training, including six (6) hours specific to dementia care and four (4) hours specific to postural supports, restricted health conditions, and hospice care, before working independently with residents. The Administrator expressed understanding and agreed to complete the required trainings with S1. Six (6) resident files were reviewed. Resident #1’s (R1) file was observed to contain an admission agreement for a different facility. LPA informed the Administrator who stated that R1 was transferred to this facility but no new admission agreement was created because both facilities are run under the same Operator. LPA informed the Administrator that admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, and the licensee or the licensee’s designated representative no later than seven (7) days following admission. The Administrator expressed understanding and agreed to complete an admission agreement for R1. MEDICATION REVIEW: Medication review began at 11:45 AM. Medications for three (3) of six (6) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction 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 they pertain to infection control are adequate. Emergency disaster drills are to be conducted quarterly the Administrator was unable to provide LPA with documentation that showed the facility’s last emergency disaster drill. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. Continued on LIC 809C. INTERVIEWS: LPA interviewed three (3) residents and two (2) staff members. All three (3) residents interviewed had concerns relating to the variety of food served at the facility. LPA informed the Administrator of the concerns regarding the variety of foods offered for meals. The Administrator agreed to implement a more robust and varied menu for the dinner service at the facility. One (1) staff interview was conducted with the assistance of the facility Administrator acting as a translator. Both staff members interviewed understood their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. 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 deficiencies were cited. (refer to LIC 809-Ds): Exit interview conducted and copy of the report was issued and appeal rights provided.