Routine inspection·May 20, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 10:45AM. The LPA was greeted by staff, informed them of the reason for the visit, and staff proceeded to notify the Administrators. Assistant Administrator Ayalla Levy arrived shortly thereafter, and Administrator Izhak Illouz arrived at 11:07AM. Entrance interview conducted. Beginning at 10:51AM, the LPA, House Manager, and Assistant 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: BEDROOMS/RESTROOMS: There are seven (7) total bedrooms; six (6) private resident bedrooms and one (1) locked staff bedroom. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are stored in the hallway cabinets. There are seven (7) total restrooms in the facility: five (5) attached private resident restrooms, one (1) designated staff and visitor restroom, and one (1) detached private restroom for one (1) resident. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 107.4 degrees F and 135.5 degrees F, which was not in the required range of 105 degrees F and 120 degrees F. Administrator Izhak lowered the water heater during the visit, but was unsuccessful in lowering the water temperature. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. LPA observed residents and staff participating in a weekly music class and noted additional activities stored in the living room. Required postings were located in the living room near a closet that contained general storage. A locked laundry room was located in the hallway and contained an operable washer/dryer, laundry supplies, and household cleaning supplies. The facility maintained a comfortable temperature throughout the visit. Smoke and carbon monoxide detectors were tested at 12:42PM and were operational at the time of the visit. Fire extinguishers were observed throughout the facility and was last serviced on 01/03/2025. KITCHEN: The LPA observed the facility kitchen at 11:10AM. Knives are stored inaccessible in a locked drawer between the stove and sink. Cleaning supplies were stored inaccessible and locked under the sink. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food and water within regulation. Food in the refrigerator and freezer were observed to be properly stored. OUTDOOR AREA: The surrounding grounds had multiple shaded patio areas equipped with furniture in good condition for resident and visitor use. There is one driveway gate used for emergency exits with two pathways on both sides of the house that lead to the front yard/driveway. No bodies of water noted, and exits are free of obstructions. The LPA observed three (3) sheds in the backyard that stored extra freezer foods, extra emergency food and water, and general storage. The sheds remain locked and inaccessible to residents in care. RECORDS: Record review began at 11:25AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. LPA observed two (2) out of six (6) staff did not have a health screening, and one (1) out of six (6) staff did not have a TB test upon their employment with the facility. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 04/30/2025. MEDICATIONS: Medication review began at 2:30PM. Medications are centrally stored and kept inaccessible in the hallway closet. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Three (3) staff and two (2) family members of residents were interviewed. No complaints noted. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted. A copy of the report and appeal rights were provided.