Routine inspection·July 13, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Zara Pghosyan and explained the reason for the visit. The facility is licensed to served 85 ambulatory and 14 non-ambulatory residents ages 60 and above. Non-ambulatory residents in first floor only. Hospice waiver approved for 15 residents. The facility is located in a residential area and consist of a large two story building. First floor has a commercial kitchen, two dining rooms, a courtyard, a lobby, office space, resident rooms, and a front patio. Second floor has resident rooms, medication room. Storage spaces are throughout the facility. LPA conducted a tour of the facility with Zara Pghosyan and observed the following: Facility is in good repair indoor and outdoor. Commercial kitchen is clean, and food supplies were stored sufficient for at least two days of perishables and 7 days of non-perishables. Common areas are clean and in good repair. All the required postage was observed throughout the first floor. LPA observed 8 randomly chosen resident rooms which have sufficient lighting, the required furniture, and bedding supplies. Water temperature was tested in each bathroom and tested between 97.7 - 117.2 degrees F. which is not within the required 105-120 degrees F. Bathrooms were observed to have the required grab bars and skid strips on showers. Call system was tested in 4 rooms and receptionist responded to each call immediately. No large bodies of water were observed. Facility has a fire sprinkler system throughout. Smoke/Carbon monoxide detectors were tested in each room and are in working condition. LPA reviewed medication and files for 5 residents and Emergency Disaster Plan LIC 610E (10/03) dated 9/19/23. Last emergency drill was conducted 5/26/24. During this visit LPA conducted the following CARE tool domains:Operational Requirements, Physical Plant/Environmental Safety, Resident Rights/Information, Planned Activities, Food Service, Incidental Medical and Dental, Resident Records/Incident Reports, Disaster Preparedness. Due to time LPA will return at a later time to finish the remaining domains. Deficiency was noted on LIC 809D, and technical violations were noted. Exit interview was conducted and a copy of this report, LIC 809D, and appeal rights were provided.