Routine inspection·March 28, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:28 AM. LPA met with facility staff who contacted the facility Administrator Anna Atayan. The Administrator arrived to the facility at 09:49 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:50 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: KITCHEN : The 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 drawer to contain knives and other sharp objects. LPA observed a secured cabinet to contain resident medications. The facility’s washer and dryer are located in the kitchen and a door to the garage was observed to be locked and inaccessible to clients in care. LPA observed a camera covering the kitchen area and entrance to the garage. LPA confirmed with the facility Administrator that audio is not recorded. GARAGE: LPA observed the garage to be inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, emergency water supplies, and an extra refrigerator. Continued on LIC 809C. COMMON AREAS : This includes the living room, Administrator’s office, hallway, and dining area. LPA observed all common areas of the facility to be clean and all furniture was observed to be in good repair. The living room contains a television, activities, and adequate seating for resident use. The Administrator’s office is located at the front of the facility and contains facility and resident files. LPA observed a hallway closet to contain extra linens and care supplies. The dining area is attached to the kitchen and contains adequate seating for resident use. LPA observed the dining area and hallway to contain fire extinguishers. Fire extinguishers were observed to be fully charged and purchased on 02/24/2025. The facility’s combination fire and carbon monoxide alarms, as well as the facility fire door, were tested at 10:23 AM and were functional at the time of the visit. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard; LPA observed clear passageways on either side of the facility for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the backyard to contain ramps and handrails leading from the exits of resident rooms. All ramps were observed to be in good repair and all handrails were properly secured. BEDROOMS : There are six (6) bedrooms in the facility; all six (6) bedrooms are single occupancy rooms. LPA and facility Administrator toured all six (6) resident rooms. All resident rooms were observed to be clean and were 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. Bedrooms # 2,3,4,5, and 6 all contain direct exits to the outdoors of the facility. BATHROOMS : There are four (4) bathrooms at the facility. Two (2) bathrooms are designated as private resident bathrooms, and two (2) bathrooms are designated as a shared resident bathrooms. All 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 106 and 109 degrees Fahrenheit, which is in compliance with regulation. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:25 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 contained all required documentation and signatures. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 11:25 AM. Medications for three (3) of five (5) 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 it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 03/21/2025. 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 and two (2) staff members. Both residents interviewed stated that the staff treat them well and are attentive to their needs. Both residents had no concerns or recommendations for improvement for the facility. Both staff interviews were 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. No deficiencies were observed during today’s inspection. Exit interview conducted and copy of the report was issued.