Routine inspection·February 4, 2026

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:32 AM. LPA met with facility staff who contacted the facility Administrator Nelli Tadevosyan. The Administrator arrived to the facility at 09:53 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:55 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: BEDROOMS : There are four (4) bedrooms in the facility; three (3) are dual occupancy resident rooms and one (1) is a staff room. LPA and facility Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. One (1) resident bed was observed to contain full bed rails. Auditory alarms were observed on facility exits and all were functional at the time of the visit. BATHROOMS : There are two (2) bathrooms at the facility. One (1) bathroom is designated as private resident bathroom, and one (1) bathroom is designated as a shared resident bathroom. Both resident 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 112.5 and 116.4 degrees Fahrenheit, which is in compliance with regulation. LPA observed both bathrooms to contain appropriately secured under-sink cabinets which contained cleaning supplies and personal grooming supplies. Continued on LIC 809C. COMMON AREAS : This included the living room, hallway, and dining area. LPA observed the dining area to be clean and properly furnished at the time of the visit. The dining area contained a dining table with adequate seating for resident use. The dining area contained a cabinet and drawers with activities for resident use. LPA observed a fire extinguisher mounted in the dining area to be fully charged and purchased on 01/15/2026. The living room was observed to be clean and in good repair. The living room contained adequate seating for resident use. LPA observed the living room to contain an adequately screened fireplace. LPA observed the hallway closet to contain extra linens. The facility’s combination fire and carbon monoxide alarms were tested at 10:25 AM and were functional at the time of the visit. OUTDOOR SPACE: The facility has one (1) emergency exit gate located on the side of the home. LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the facility’s backyard to contain an appropriately fenced off pool that was inaccessible to residents in care. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, an extra refrigerator, an extra freezer and the facility’s washer and dryer. 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 cabinet which contained resident medications and a complete first aid kit. LPA observed a properly secured under-sink cabinet which contained cleaning supplies. One (1) cabinet was observed to contain adequate emergency food and water supplies. The oven was observed to be equipped with child proofing knobs. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:52 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. All staff files contained all required documents and trainings. Four (4) resident files were reviewed. One (1) resident’s bed was observed to contain full bed rails and the resident was observed to not be enrolled with hospice. LPA informed the Administrator that bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. The Administrator expressed understanding and removed the bed rails at the time of the visit. MEDICATION REVIEW: Medication review began at 12:42 PM. Medications for four (4) of four (4) residents were observed. LPA observed three (3) resident’s Centrally Stored Medication and Destruction record sheets (CSMDR) to have medications quantity and strength improperly documented. LPA observed one (1) resident’s CSMDR to contain inaccurate administration instructions for one (1) medication and for one (1) additional medication to not be logged on the CSMDR. LPA informed the Administrator who immediately corrected the errors on the CSMDRs. 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 conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/12/2026. 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. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. Two (2) staff members were interviewed utilizing telephonic translation services. Both staff members interviewed were knowledgeable on the resident’s 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 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-D): Exit interview conducted and copy of the report was issued and appeal rights provided.