Routine inspection·September 10, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:14 AM. LPA met with facility staff who contacted the facility Administrator Mary Petikyan via telephone call. The facility Administrator arrived to the facility at 10:26 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:26 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 : LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. LPA observed a secured drawer to contain knives as well as a secured cabinet located under the sink which contained cleaning supplies. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed the facility’s non-perishable food supply to contain four (4) cans of food that were approximately one (1) month past their expiration date and one (1) additional can that was dented. LPA informed the Administrator, who immediately removed the cans from the storage. Additionally, during the visit the Administrator conducted an audit of the facility’s food supplies to ensure no items near their expiration date were retained. BEDROOMS : There are seven (7) bedrooms in the facility; six (6) are designated as single occupancy resident rooms and one (1) is designated as a staff room. LPA and facility Administrator toured all seven (7) bedrooms. 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 were functional at the time of the visit. LPA observed the staff bedroom to be properly secured. Additionally, the staff room contained an extra refrigerator, an adequate supply of emergency water, and extra care supplies. Report Continued on LIC 809-C BATHROOMS : There are four (4) bathrooms at the facility. Three (3) 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. Grab bars were observed in all showers and near all toilets, all were properly secured. The water temperature was measured between 106.2 and 109 degrees Fahrenheit, which is in compliance with regulation. Two (2) hallway bathrooms were observed to contain appropriately secured storage cabinets that contained resident grooming supplies. COMMON AREAS : This includes the living room, dining room, and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains a television, activities for resident use, and an appropriately screened fireplace. The dining room was observed to be clean and contains adequate seating for resident use. LPA observed the hallway to contain a secured laundry room that contained a washer and dryer as well as detergents and cleaning supplies. Additionally, LPA observed a hallway closet to contain clean linens for resident use. All furniture throughout the facility was observed to be clean and in good repair. The LPA observed two (2) fire extinguishers throughout the facility to be fully charged and purchased on 04/24/2025. Smoke detectors and carbon monoxide detectors were tested at 10:57 AM and were functional at the time of the visit. OUTDOOR SPACE: The facility has two (2) emergency exit gates located in the front yard; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed two (2) appropriately secured sheds to contain gardening supplies and decorations. LPA observed cameras located on the exterior of the facility. RECORD REVIEW: Record review began at 11:00 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. Six (6) staff files were reviewed. All staff files contained the required documents. Six (6) resident files were reviewed. All resident files reviewed contained all required documentation. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 12:25 PM. Medications are stored centrally and securely in a cabinet in the living room. Medications for two (2) residents were observed. All medications observed were documented appropriately on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Report Continued on LIC 809-C 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 and the last emergency disaster drill was conducted on 07/14/2025. 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 one (1) staff and one (1) resident. The resident interviewed stated that staff treat them very well and are attentive to their needs. The resident interviewed had no concerns with the facility. The staff member interviewed was knowledgeable on their roles and responsibilities, the resident 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 deficiency was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.