Routine inspection·October 6, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:30 AM. LPA met with Administrator Lilit Tonoyan. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:35 AM, the LPA, along with 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: BEDROOMS : There are five (5) bedrooms in the facility; four (4) are single occupancy resident rooms and one (1) is a dual occupancy resident room. LPA and the Administrator toured all five (5) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on facility exits and were functioning at the time of inspection. Bedrooms #3 and #5 contain direct exits to the outdoors of the facility. LPA observed Resident #1 (R1)’s bedroom to contain two unsecured inhalers. LPA reviewed R1’s file and observed that R1 was determined by their physician to not be able to store their own medications. LPA informed the Administrator who immediately secured the two inhalers. Continued on LIC 809C. BATHROOMS : There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared/common resident bathrooms and one (1) is designated as a private resident bathroom. All bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in resident showers and near resident toilets, all were properly secured. The water temperature was measured between 114.6 and 118.4 degrees Fahrenheit, which is in compliance with regulation. 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 two (2) secured drawers to contain knives and other sharp objects. LPA observed a locked under-sink cabinet to contain cleaning supplies. LPA observed a wall mounted fire extinguisher to be fully charged and last serviced on 09/04/2025. COMMON AREAS : This includes the living room, dining area, Administrator’s office, and hallways. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a couch, a television, and activities for resident use. Additionally, the living room was observed to contain an appropriately screened fireplace. The dining area was observed to be clean and contained adequate amounts of seating for resident use. LPA observed all required postings for the facility located on the dining area wall. The Administrator’s office was observed to contain locked cabinets which contained resident medications, facility files, personal grooming supplies, and additional care supplies. The hallway was observed to contain the facility’s washer and dryer and a storage cabinet that contained bleach bottles. At 10:44 AM LPA observed this storage cabinet to be unlocked at the time of the inspection. LPA notified the Administrator of the accessible chemicals. The Administrator had the chemicals secured at the time of the inspection. Combination fire and carbon monoxide alarms and fire doors were tested at 10:52 AM and functioned properly at the time of inspection. LPA observed cameras throughout the common areas of the facility. The Administrator confirmed that the cameras do not record audio. Continued on LIC 809C. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard of the facility. All fences/railings at the facility were secured properly. LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the back yard to contain two (2) properly secured sheds that contained extra care supplies and gardening equipment. LPA observed a properly secured garage located in the yard of the facility. LPA inspected the garage and was informed by the Administrator that Individual #1 (I1) was residing in the garage. LPA observed the garage to contain furniture consistent with an individual residing in the building including but not limited to: a sink, cabinets, a couch, Etc. LPA reviewed the facility’s approved fire clearance and observed a note which stated “Garage to be used as a garage only.” LPA informed the Administrator who stated that they have obtained a sketch of the building but have not completed the application to convert the building into an ADU. LPA informed the Administrator that having an individual residing in the garage is a direct violation of their fire clearance. LPA explained that fire clearance violations are a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (10/06/2025). LPA informed Administrator that failure to adhere to the requirements of their fire clearance may result in the assessment of additional civil penalties. 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, first aid certification, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained the required documentation and trainings. Three (3) resident files were reviewed. All resident files contained all required documentation and signatures. During record review LPA did not observe I1 to be associated to the facility. LPA informed the Administrator who stated that I1 is finger print cleared but works for another facility. The Administrator stated that I1 has resided at the facility since July of 2025. LPA informed the Administrator that any individual, prior to working, residing or volunteering in a licensed facility, shall be finger print cleared and associated to the facility. LPA explained that since I1 had resided at the facility since July and was not associated to the facility an additional civil penalty in the amount of $3000 will be assessed on today’s date (10/06/2025). LPA informed the Administrator that this is their second violation of CCR 87355(e)(3) within a 12 month period. LPA informed Administrator that failure to associate I1 to the facility may result in the assessment of additional civil penalties. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 01:07 PM. Medications are stored centrally and securely in a cabinet in the Administrator’s office. Medications for two (2) residents were observed. All medications observed were documented appropriately on their 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 09/02/2025. 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) staff and one (1) resident. The resident interviewed stated that the staff treat them well and are attentive to their needs. The resident interviewed had no concerns with the facility. The staff member interviewed was knowledgeable on their role and responsibilities, resident rights, the different 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 liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies and civil penalties were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.