Routine inspection·January 5, 2026

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:15 AM. LPA met with facility staff who contacted the facility Administrator Nurista Martinyan. The Administrator arrived to the facility at 10:39 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:40 AM the LPA, along with the 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: BEDROOMS : There are four (4) bedrooms in the facility; two (2) are single occupancy resident rooms and two (2) are dual occupancy resident rooms. LPA and the Administrator toured all four (4) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms #1 and #2 contained direct exits to the outdoors of the facility. All direct exits were observed to contain functioning auditory alarms. BATHROOMS : There are two (2) bathrooms at the facility. One (1) is designated as a private resident bathroom, and one (1) is designated as a shared/common resident bathroom. Both resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed near resident toilets and were properly secured. The water temperature was measured to be between 113.2 and 113.4 degrees Fahrenheit, which is in compliance with regulation. Continued on LIC 809C. COMMON AREAS : This included 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 and a fireplace. The fireplace was appropriately screened and contained no tools. The hallway was observed to contain storage closets which contained extra care supplies, and emergency food and water supplies. 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, along with the fire door, were tested at 11:19 AM and were functional at the time of the visit. KITCHEN : 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 lock box which contained knives and other sharp objects. Additionally, the kitchen contained a locked under-sink cabinet that contained soaps and cleaning chemicals as well as a locked cabinet that contained medications. LPA observed a fire extinguisher mounted on the wall to be purchased on 11/06/2024. LPA informed the Administrator that this was more than twelve (12) months from the inspection date. The Administrator had a new fire extinguisher purchased and installed at the time of the visit. OUTDOOR SPACE: The facility had one (1) emergency exit gate located in the front of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. The backyard was observed to contain a secured shed which contained care supplies and gardening supplies. LPA observed an unsecured saw blade and motor oil in the back yard of the facility. LPA informed the Administrator who secured the items at the time of the visit. RECORD REVIEW: Record review began at 11:27 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. Two (2) resident files were reviewed. Both resident files had admission agreements that were printed on two sides of the paper. LPA informed the Administrator that the print in the agreement shall appear on one side of the paper only. One (1) admission agreement was observed to be missing the rate for all basic services which the facility is required to provide. Continued on LIC 809C. RECORD REVIEW CONT: Both resident files were observed to contain incomplete appraisal needs and services plans which were missing signatures. Both resident files were observed to be missing signed copies of the resident’s personal rights. Resident #1 (R1)’s bed was observed to contain full bed rails. LPA reviewed R1’s file and did not observe R1 to be enrolled with a hospice company. LPA informed the Administrator that bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. The Administrator removed the full bed rails from R1’s bed at the time of the visit. MEDICATION REVIEW: Medication review began at 12:50 PM. Medications for two (2) of two (2) residents were observed. R1’s medication count did not correspond with the start date listed on their centrally stored medication and destruction record (CSMDR). LPA informed the Administrator who stated that R1 came with multiple packets of their medications. LPA reviewed R1’s CSMDR and did not observe any additional packages of medications listed. 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 in October 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 one (1) resident. The resident interviewed stated that the staff treat them well and are attentive to their needs. The resident 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 deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.