Post-licensing visit·July 11, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a post-licensing visit at 10:04AM. The LPA met with the Licensee Naira Nikoyan and explained the reason for the visit. Entrance interview conducted. Beginning at 10:12AM, the LPA and the Licensee 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: COMMON AREAS: At the time of the visit, two (2) living rooms were observed with furniture in good condition. The facility’s entryway had an extra supply of linens and supplies. Required postings were observed in the first living room. LPA observed an unoccupied bed in the first living room and the Licensee understood it needed to be removed. The second living room had an office area with a locked cabinet that stored extra medications. LPA observed Resident #1 (R1) residing in the second living room who was also observed at 12:03PM to be Bedridden. The Licensee stated R1 was admitted two (2) days ago and Hospice had placed them there. The LPA notified the Licensee that R1 will need to be relocated to the approved Bedridden bedroom by the end of today, 07/11/2025. Emergency food and water were stored in a hallway pantry. The facility maintained a comfortable temperature throughout the visit. Smoke and carbon monoxide detectors were tested at 10:52AM and were operational at the time of the visit. Report Continued on LIC 809-C KITCHEN: Knives and Medications were stored inaccessible in a locked cabinet. However, LPA observed accessible steak knives in a cabinet across from the refrigerator. Additionally, the Medication fridge near the same cabinet was not secured. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food. LPA observed operating laundry machines in a kitchen closet that also stored extra facility supplies. BEDROOMS/RESTROOMS: There were three (3) total bedrooms with dual occupancy. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom #1 was approved for one (1) Bedridden resident and had a direct exit to the outside. Bedroom #3 had a direct exit to the outside and LPA observed Resident #2 (R2) had access to their Insulin Pen Needles and had a needle disposal bin on their bedside. After reviewing Physician’s Reports, R2 and Resident #3 (R3) residing in Bedroom #3 were not allowed access to store their own medications and pose a safety risk. The Licensee stated that R2 did not want assistance with their Insulin, and the Licensee allowed R2 to have possession of it. There were three (3) total restrooms in the facility: one (1) private restroom attached to Bedroom #1, one (1) guest restroom in the hallway, and one (1) shared resident restroom in the hallway. The restrooms were clean and sanitary. Hot water was tested and measured between 118 degrees F and 118.9 degrees F, which is within the required range. OUTDOOR AREA: The outdoor area consisted of the front yard and rear patio. The LPA observed two (2) aerosol bug repellent sprays on the patio furniture. The front yard had two (2) driveway gates that were remote and manually operated, with an additional gate entrance for everyday use. LPA observed an accessible Additional Dwelling Unit (ADU) in the rear which was occupied by the Licensee and their family. The side of the ADU had two (2) sheds: one (1) contained various tools and was unlocked, and one (1) shed contained general storage that was locked. No bodies of water noted, and exits are free of obstructions. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 10:57AM. Medications were centrally stored and kept inaccessible in the kitchen and office area. Medications were observed for two (2) residents. No immediate concerns were observed. RECORDS: Record review began at 12:13PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Residents’ documentations were not complete at this time. LPA was unable to review Personnel records due to the facility not completing them upon the Staff’s employment. Additionally, two (2) Staff did not obtain their fingerprint clearance per regulation. One (1) Staff requested clearance but was not cleared due to an incomplete application. Due to time constraints, the LPA will return at a later date to conduct a continuation visit. Pursuant to Title 22 of the CA Code of Regulations and/or Health and Safety Code, the following deficiencies were cited. (Refer to LIC 809-D). An immediate civil penalty of $500 for a violation of the facility’s fire clearance was issued (Refer to LIC 412M). The Licensee understands that continued violation of the facility’s fire clearance may result in additional civil penalties. An immediate civil penalty of $100 per day for a maximum of 5 days in the amount of $1,000 for employment without a criminal record clearance and/or exemption was issued for two (2) Staff (Refer to LIC 421BG). The Licensee understands that continued employment without a criminal record clearance and/or exemption may result in additional civil penalties. Exit interview conducted. A copy of the Appeal Rights and today’s report was reviewed and provided.