Routine inspection·October 22, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:17 AM. LPA met with Administrator Erna Vanoyan. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:17 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 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 to contain knives and other sharp objects. LPA observed a secured cabinet located under the sink which contained cleaning supplies. LPA observed resident medications to be locked in a cabinet located in the kitchen. LPA observed a fire extinguisher located in the kitchen to be fully charged and purchased on 08/04/2025. 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. Continued on LIC 809C. 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. LPA observed bedroom #4 to contain a direct exit to the outdoors of the facility. This exit was observed to be partially blocked by a resident bed. LPA informed the Administrator who rearranged the layout of the resident beds at the time of the visit to allow easy passage for residents. BATHROOMS: There are two (2) bathrooms at the facility. One (1) hallway 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 105.4 and 110.1 degrees Fahrenheit, which is in compliance regulation. COMMON AREAS: This includes the living room and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained 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. The facility’s combination fire and carbon monoxide alarms along with the facility’s fire doors were tested at 11:00 AM and functioned properly at the time of the visit. OUTDOOR SPACE: The facility has two (2) emergency exit gates located in the front yard, one (1) is utilized as an emergency exit gate and one (1) is utilized as the main entry gate. LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. Continued on LIC 809C. RECORD REVIEW: Record review began at 11:02 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. All staff files contained all required documentation and trainings. Five (5) resident files were reviewed. All resident files were observed to contain Appraisal Needs and Services Plans that contained identical information. LPA informed the Administrator that Appraisal Needs and Services Plans should identify the needs specific to the individual the plan is created for. The Administrator expressed understanding and agreed to complete updated Appraisal Needs and Services Plans for all residents specific to the individuals. MEDICATION REVIEW: Medication review began at 01:13 PM. Medications for five (5) residents were observed. All medications observed were stored properly and were documented appropriately 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. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 09/29/2025. The facility’s emergency disaster plan and infection control plan are up to date and are 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 two (2) residents. Both residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had any concerns with the facility. The staff member interviewed was knowledgeable on their role 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 current 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.