Routine inspection·October 27, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:56 AM. LPA met with facility staff who contacted the facility Administrator Ani Palezyan. The Administrator arrived to the facility at 10:25 AM. Entrance interview was conducted and the reason for the visit was explained. Beginning at 10:17 AM the LPA, along with staff #1 (S1) and later the 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: 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 contained activities for resident use including a tablet device and a television. The living room contained locked cabinets and drawers which contained resident medications and resident, staff, and facility files. LPA observed the living room to contain a complete first aid kit and the facility’s telephone. The hallway was observed to be clean and free from any obstructions. The hallway contained the facility’s washer and dryer. The dining area was observed to be equipped with adequate seating for resident use. The dining area contained all required postings and a locked storage closet which contained hygiene items and cleaning/laundry chemicals. The facility’s combination fire and carbon monoxide alarms were tested at 01:13 PM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. Continued on LIC 809C. 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 secured under-sink cabinet to contain knives and other sharp objects stored in the same cabinet as cleaning chemicals. LPA informed the Administrator that utensils shall not be stored with toxic substances. The Administrator expressed understanding and immediately moved the chemicals to the dining area locked storage. LPA observed the kitchen to contain a wall mounted fire extinguisher to be fully charged and purchased on 07/10/2025. BEDROOMS : There are three (3) bedrooms in the facility; all are dual occupancy resident rooms. LPA and the facility Administrator toured all three (3) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms #2 and 3 contained a direct exit to the outdoors of the facility. BATHROOMS : There are two (2) bathrooms at the facility. One (1) is designated as a shared/common resident bathroom and one (1) is a private resident bathroom. Both 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. Water temperature was measured to be between 109.0 and 113.0 degrees Fahrenheit, which is in compliance with regulation. OUTDOOR SPACE: The facility has one (1) emergency exit gate located at the front of the facility; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the outdoors of the facility to contain an extra refrigerator. LPA observed cameras located throughout the outdoors of the facility. RECORD REVIEW: Record review began at 11:00 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. Four (4) staff files were reviewed. All staff files contained all required documents and trainings. Five (5) resident files were reviewed. All resident files contained all required documentation and signatures. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 01:16 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 they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 10/01/2025. 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. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. The residents interviewed had no concerns with the facility. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on their roles 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 cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.