Routine inspection·February 25, 2025

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:15 A.M. LPA met with facility Administrator Nelly Sadoyan and discussed the reason for today's visit. At 10:45 A.M. House Manager, Hrant Narinyan joined the visit. Entrance interview conducted. At 10:30 A.M., LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire Extinguisher was observed to be fully charged and purchased during today’s visit. Hardwired combination smoke detectors and carbon monoxide detectors were tested at 12:52 P.M. and were functional at the time of the visit. COMMON SPACES: In the common areas, including dining room and living room, walls and flooring were checked for cleanliness and good condition. At the time of the visit, furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which was adequately screened. Auditorial signal was observed to be in working conditions at the time of the visit. Facility has three fire doors to contain a fire from one side of the house to the other side. At the time and during the visit, LPA observed two (2) doors kept open by a chair in room number #2 and by a walker in room #3. These items prevent fire door from closing and violates fire codes. During today’s visit administrator removed items and fire doors were closed. LPA observed a ring doorbell, administrator did not know that a waiver is required to have ring doorbell. LPA did not cite but advised the licensee to submit a waiver for the Ring doorbell due to the audio component, to update plan of operation and admission agreement. Continued on LIC 9099-C Continued from LIC-9099 BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, and sufficient lighting. There are three (3) total bedrooms. Two (2) shared rooms and one (1) private room. BATHROOMS: The LPA observed 2 shared bathrooms and one shower room equipped with just a shower stall. Grab bars, slip-resistant mat and a shower chairs were observed. Resident restrooms are clean and sanitary. Between 10:31 A.M. and 10:47 A.M. hot water temperature was measured in all residents’ bathrooms, however, measurements were above the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. During today’s visit administrator lower the temperature gage on the main water tank to maintain a range of 105-120 degree F. LPA observed cleaning supplies and disinfectants inside a locked cabinet under the sink in hallway bathroom. KITCHEN : Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency supply. LPA conducted a review of expiration dates on product labels. LPA observed locked medication inside the refrigerator. All knives and sharps were observed to be locked and properly stored at the time of the visit. At 10:50 A.M. hot water temperature measured at 139.5 degrees Fahrenheit. Cleaning compounds were and separately from food supplies. OUTDOOR SPACE: The front yard area includes a gazebo furnished with a table and chairs for resident use. At the time of the visit LPA observed that the cover, which is design to provide shade for individuals seated beneath the gazebo, was missing. The administrator stated that the cover had been torn off by the wind and that a replacement will be purchased. Technical Violation (TV) issued. There is one (1) side gate doors with self-latching mechanisms. Passageways were observed to be clear and free of hazards. There were no bodies of water noted. LAUNDRY ROOM: The washer and dryer were observed inside a closet located between the kitchen and the office. At the time of the visit, the closet door was unlocked. LPA did not observe any cleaning supplies or detergents inside the closet at the time of the visit. Continued from LIC 9099-C Continued from LIC-9099C OFFICE: Located in the central area of the residence is an office. During today’s visit, the LPA observed that this office has doors leading to both wings of the house, and these doors were unlocked and wide open. The office is used by the administrator to store resident and employee files. Additionally, the LPA observed an unlocked chest of drawers located adjacent to the file cabinet; within two (2) of the drawers, medication such as TUMS, Pepto-Bismol, Cream USP 2.5%, Gas relief and Tylenol were noted. According to the administrator, these medications belong to the staff/caregivers. After reviewing resident’s records LPA observed that no current resident is at risk if allowed access to personal grooming and hygiene items. Technical Violation (TV) issued. Furthermore, the LPA observed a closet containing clothing items, emergency water, extra paper towels and an emergency grab-and-go bag with flashlights and resident’s spare files. DETACHED GARAGE: During today’s visit LPA inspected the detached locked garage. LPA observed wheelchairs and boxes. The garage stores items that belong to the property owner. Although the facility sketch includes the garage, the lease agreement between administrator and homeowner explicitly states that the garage space is not included in the lease and the homeowner retains access to this space at any time during the term of the lease. RECORD REVIEW: Began at 12:45 P.M., 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, and personal rights. Two (2) resident records reviewed were missing consent form (LIC 627C). LPA emailed form to administrator and requested to include it in current and future residents. Technical Assistance was issued. Administrator will provide proof of complete form both resident. All other required forms were complete and up to date. Three (3) staff files reviewed, all containing necessary documents. Continued on LIC 9099-C Continued from LIC 9099-C MEDICATION REVIEW: Began at 2:00 P.M.; LPA reviewed medication log for all four (4) residents. Facility maintains medication in a locked kitchen cabinet. Medications are labeled and checked for expiration dates. During medication audit, LPA observed that administrator has medication for all 4 residents separated in a weekly pill organizer. LPA explained that medication shall be stored in its originally received container. LPA also reviewed the facility's Emergency Disaster Plan and Infectious Control Plan, which were observed to be complete and updated on 1/5/2025. Emergency Disaster drills are conducted quarterly, with the last drill documented on 1/5/2025. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. A $500 immediate civil penalty is assessed today. The administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, appeal rights discussed, and a copy of this report issued.