Routine inspection·October 4, 2024

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:23 AM. LPA met with facility staff who contacted facility administrator Erna Vanoyan via telephone call. The facility administrator arrived to the facility at approximately 09:46 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:46 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/LAUNDRY : The LPA observed the kitchen area to be clean. Kitchen appliances were 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 as well as a secured cabinet located under the sink which contained cleaning supplies. LPA observed a fire extinguisher located in the kitchen to be purchased on 06/10/2024. LPA observed the laundry to be located adjacent to the kitchen. LPA observed a secured cabinet in the laundry to contain detergent and extra cleaning supplies. LPA observed the laundry to contain adequate emergency food and water supplies. BEDROOMS : There are four (4) bedrooms in the facility; two (2) are single occupancy rooms and two (2) are dual occupancy rooms. Bedroom number one (1) is designated as the bedridden approved room. LPA and facility administrator toured all four (4) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on all facility exits. Report Continued on LIC 809-C BEDROOMS : LPA observed bedroom number four (4) to contain three (3) beds. LPA asked the administrator who slept in the third bed and the administrator stated that it was for their use to monitor residents at night to reduce the risk of falls. LPA informed the administrator that this is a violation of CCR 87307(a). LPA informed administrator that staff are not allowed to sleep in resident rooms and that nighttime awake staff must be utilized. BATHROOMS : There are two (2) bathrooms at the facility. One (1) bathroom is designated as shared resident bathroom. And one (1) bathroom 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 113.9 and 117 degrees Fahrenheit, which is in compliance regulation. COMMON AREAS : This includes the living room. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains an appropriately screened fireplace, a couch, and activities for resident use. LPA observed a hallway closet to contain extra linens and care supplies. LPA observed all required postings for the facility near the entry way. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard, LPA observed the facility’s emergency exit gate to fail to self-latch at the time of the visit. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. RECORD REVIEW: Record review began at 10:21 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, first aid certification, consent forms, and personal rights. Three (3) staff files were reviewed. One staff file reviewed did not contain a first aid certification. Six (6) resident files were reviewed. All resident files reviewed contained all required documentation. Report Continued on LIC 809-C MEDICATION REVIEW: Medication review began at 11:44 AM. Medications are stored centrally and securely in a cabinet in the kitchen. LPA observed medications for one (1) resident to be prepared using a Sunday-Saturday medication organizer which is not in compliance with regulation. Medications for four (4) residents were observed. All medications observed were documented appropriately on their centrally stored medication and destruction record sheets. 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 to be conducted quarterly; the facility’s last emergency disaster drill was conducted on 06/21/2024 which is not in compliance with regulations. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan were reviewed/updated annually by the facility’s administrator. INTERVIEWS: LPA interviewed one (1) staff and three (3) residents. All residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. The staff member interviewed was knowledgeable on their role and responsibilities, 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 deficiencies were cited (refer to LIC 809-Ds): Exit interview conducted and copy of the report was issued and appeal rights provided.