Routine inspection·May 20, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:04 AM. LPA met with facility staff who contacted the facility Administrator Gamlet Kuyumchyan and facility Designee Liana Atabekyan. The Administrator and Designee arrived to the facility at 10:25 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:26 AM the LPA, along with facility Administrator and facility Designee 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 : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a fire extinguisher mounted on the wall to be purchased on 05/07/2025. The kitchen contained a locked under sink cabinet. BEDROOMS : There are four (4) bedrooms in the facility; three (3) are dual occupancy resident rooms and one (1) is a staff room. LPA, facility Administrator, and facility Designee toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #1 contains a direct exit to the outdoors of the facility. Continued on LIC 809C. COMMON AREAS : This includes the living room, hallway, and dining area. 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 a camera. LPA confirmed with the facility Designee that audio is not recorded. The hallway was observed to contain a locked medication cart that contained resident medications, the facility first aid kit, and a secured drawer that contained knives and other sharp objects. Additionally, the hallway contained a storage closet which contained extra linens for resident use. The dining area was observed to be equipped with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:47 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. BATHROOMS : There are two (2) bathrooms at the facility. One (1) designated as a private resident bathroom, and one (1) is designated as a shared/common resident bathroom. All resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 109.0 and 112.3 degrees Fahrenheit, which is in compliance with regulation. OUTDOOR SPACE: The facility has two (2) emergency exit gates located on either side of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed cameras located throughout the outdoor areas of the facility. LPA observed a closet located on the outside of the facility to contain the facility’s washer and dryer. LPA observed a secured outdoor cabinet to contain cleaning and laundry chemicals, resident grooming supplies, and household tools/chemicals. STORAGE/ADMINISTRATOR OFFICE: LPA observed the Administrators office to be inaccessible to clients in care. The Storage room contained an extra freezer and an extra refrigerator. Additionally, the storage contained adequate emergency food/water supplies and extra care supplies. 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, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained all required documents and trainings. One (1) staff file reviewed, staff #1 (S1), revealed that S1 was not associated to the facility. LPA asked the Designee why S1 was not associated. The Designee informed LPA that S1 has worked for licensed facilities previously and is fingerprint cleared. LPA informed Designee that they must request a transfer of a criminal record clearance for S1 prior to S1 working, residing or volunteering in a licensed facility. LPA confirmed that S1 has worked for the facility since 01/01/2025. LPA informed the Administrator and Designee that failure to request the transfer of the criminal record clearance for S1 would result in the assessment of an immediate civil penalty on today’s date (05/20/2025). The civil penalty will be assessed in the amount of $500, calculated as the number of days S1 has worked for the facility without being associated at $100/day x 5 days (Maximum of 5 days for the first violation) for a total of $500. S1 was associated to the facility on Guardian at the time of the visit. Five (5) resident files were reviewed. All resident files contained all required documentation and signatures. MEDICATION REVIEW: Medication review began at 12:50 PM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were appropriately documented 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. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 04/04/2025. 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 and/or Designee. Continued on LIC 809C. INTERVIEWS: LPA interviewed two (2) residents. Both residents interviewed stated that the staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. LPA interviewed one (1) staff member with the assistance of the Designee acting as a translator. The staff member interviewed was knowledgeable on their role and responsibilities, the resident’s rights, the 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 deficiency and civil penalty was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.