Routine inspection·December 2, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required Annual visit at 9:38AM. The LPA met with the Licensee Naira Nikoyan and explained the reason for the visit. Entrance interview conducted. Beginning at 9:59AM, 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 room and dining room furniture were observed to be in good condition. The entryway had cabinets that contained facility supplies and extra linens. There was a fireplace in the second living room, which was observed to be screened. The second living room also had an office area with a locked cabinet that contained files and additional medications. The facility maintained a comfortable temperature throughout the visit. Required postings were observed near the in the first living room and nightlights were maintained throughout the hallways. Report Continued on LIC 809-C KITCHEN: Knives and medications were stored inaccessible in a locked cabinet in addition to a secured medication fridge. Kitchen appliances were clean and in operable condition. The facility had a sufficient supply of perishable and non-perishable food, with an additional pantry in the hallway that contained emergency food and water. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. There was a closet with laundry machines that were operational and contained extra facility supplies. BEDROOMS/RESTROOMS: There were three (3) total bedrooms, each shared. Bedrooms #1 and #3 had a direct exit to the outside with Bedroom #1 approved for one (1) bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There were three (3) total bathrooms in the facility: one (1) private restroom, one (1) shared resident restroom, and one (1) visitor restroom. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. The private resident restroom had a locked cabinet that contained facility cleaning supplies. All restrooms were sufficiently stocked with soap and paper products. Hot water was tested and measured between 109.4 degrees F and 109.9 degrees F. OUTDOOR AREA: The outdoor area was shared with the rear Additional Dwelling Unit (ADU) that was occupied by the Licensee. There was sufficient outdoor furniture with shade. The LPA observed two (2) sheds that had general storage and remained locked. No bodies of water noted, and exits were free of obstructions. The side passageways led to the front yard that had two (2) remote and manual operated driveway gates and a door for everyday use. RECORDS: Record review began at 10:20AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. Resident #1 (R1) did not have a Physician’s Report or TB test completed, and consent forms were not signed. The Licensee stated R1 was having issues with their insurance and did not have a Physician. Resident #2 (R2) did not have a TB test result and consent forms were not signed. Resident #3 (R3) had unsigned consent forms and personal rights. Report Continued on LIC 808-C Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The Licensee did not have a health screening or TB test on file and stated they have an appointment to renew the documents. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 08/13/2025. Smoke and carbon monoxide detectors were tested at 11:32AM and were operational at the time of the visit. One (1) fire extinguisher was observed in the kitchen and was purchased on 07/17/2025 and fully charged. MEDICATIONS: Medication review began at 11:34AM. Medications were centrally stored and kept inaccessible in the kitchen and office cabinet. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were not properly documented on the centrally stored medications and destruction record. The Licensee did not maintain a current record for Resident #4 (R4) and requested the Hospice Agency to send the record, which did not include medication start dates. Medications for Resident #5 (R5) did not have accurate start dates. Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D). A Civil Penalty in the amount of $250 was assessed for a repeat violation. The Licensee was informed that continued violation and failure to correct the violation could result in additional civil penalties. Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.