Routine inspection·December 28, 2023

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. The LPA was greeted by staff and informed them of the reason for the visit. Licensee Kristina Adamyan arrived shortly thereafter. The LPA and the licensee 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: Knives are stored in a locked drawer in the kitchen. The facility has a sufficient supply of perishable and nonperishable food. Additional food is located in the garage. There is an adequate supply of emergency food and water. Appliances were clean and all appeared functional. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet in the kitchen and in the garage. At 1:27 p.m. the LPA and the licensee observed five cockroaches in a cupboard under the oven. Bedrooms: The facility has six bedrooms. Five rooms are designated for resident use. There are four private resident bedrooms (Rooms #1, 2, 4, 5) and one shared room (Room #3). Room #3, Room #4, and Room #5 have direct exits to the outside. Rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. Lighting in the rooms appeared adequate. Room #6 is a designated staff room. At 12:30 p.m. the LPA and the licensee observed the staff's bedroom to be unlocked. Over the counter medication (Nexium) with one pill on top of the lid, was observed within reach of the residents. The Licensee promptly removed the medication and locked the room. Bathrooms : There are four bathrooms, and out of the four bathrooms, one is designated as a staff bathroom. Restrooms are clean and sanitary with grab bars and non-skid surfaces. Rooms #3 and #5 have an attached bathroom. Restrooms were fully stocked. Hand-washing signs were observed in all restrooms. At 12:40 p.m. the LPA and the licensee observed shaving razors on top of the sink and under the sink, to be within reach of residents. The non-skid mat in the bathroom #1 was found to have mold. Common Areas: The common areas are appropriately furnished, and the lighting is adequate. Resident and staff records are stored in the garage. There is not a fireplace in the living room. Medications are stored in a locked closet near the entrance. Fire extinguishers were purchased on 11/26/2023. Smoke detectors and common monoxide detectors were tested and were operational at the time of the visit. There is a functioning telephone on the premises. Emergency exit plans are posted throughout the facility. Other required postings are near the front entrance. Outdoor Area: The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. There is a door w/gate with a self-latching mechanism for persons to enter the front yard. There is a locked storage shed in the back yard. There are no bodies of water on the premises at the present time . The garage is accessible from the house; the door was unlocked at the time of the visit at approximately 1:15p.m. The washer and dryer are in the garage, along with the cleaning supplies. RECORDS: Records review began at 2:30 p.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. Staff files were missing the annual required hours of training for staff. MEDICATIONS: Medications review began at 4:23 p.m.; medications are centrally stored and locked in a cabinet in a closet; medications are labeled and checked for expiration dates. Medications were not properly documented on the centrally stored medications and destruction record. The following errors were observed during the medication review. Medication for one resident was discontinued by physician, but no note was found in the resident’s record. Additionally, three new medications were prescribed, and doctor’s new order was missing from resident’s record as well the new medications were not listed in the Centrally Stored and Destruction Record. 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. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies are cited (refer to LICs 9099-D). The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster Deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.