Routine inspection·April 16, 2025

At 9:15 AM Licensing Program Analyst (LPA) Nadia Shahbazian, conducted an unannounced annual inspection at the facility mentioned above. LPAs met with the Karine Filikyan - Administrator and explained the reason for the visit. The total capacity of the facility is approved for six (6) non-ambulatory residents; six (6) of whom may be bedridden. Facility has an approved waiver for one (1) hospice resident. Facility is a single-story house consisting of a total of six (6) bedrooms, two (2) full bathrooms. Current census is (4) four residents, including one (1) on hospice care. At 10:45am, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detectors were tested and were functioning properly. The fire extinguisher is located in the kitchen. The charge date is 11/17/2024. Kitchen: The kitchen appliances consisted of a refrigerator, oven and microwave, and all fixtures were functional. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. Knives were stored in a drawer in the kitchen but the lock was broken. Staff immediately removed the knives and placed them in the locked medication cabinet in the kitchen. Kitchen clleaning supplies are being stored in the kitchen, underneath the sink but the lock was broken. Staff immediately removed and locked the chemicals in the garage, inaccessible to the residents. Bedrooms: There were five (5) bedrooms designated for residents' use and one (1) staff bedroom. The bedrooms in use by the residents were properly furnished with chairs, appropriate beddings and linens with sufficient lighting. One (1) of the bedrooms is currently vacant. Bathrooms: There are two (2) bathrooms, one (1) designated for residents' use and one (1) for staff use. Both bathrooms have functional grab bars, non-skid mat, and fixtures. Hot water temperature in residents' bathroom was measured at 117.8 degrees Fahrenheit. Common Areas : These included the living room, dining room and dining area in the kitchen. A properly covered fireplace was observed in the living room, even though the facility does not use the fireplace. The common areas were properly furnished with tables and chairs, appropriate with number of residents. The auditory alarms on all exit doors were observed and functional at the time of the visit. Facility is equipped with cameras in the common areas. Continued on LIC 809-C Garage: Facility has a detached garage which currently is used as storage space. The laundry is located inside the garage. LPA observed the laundry cleaning supplies, hazardous liquids, detergents locked in the garage, inaccessible to residents in care. LPA observed two extra refrigerators in the garage as well, supplied with perishable food supplies. Non-perishable emergency food supplies were also kept in the garage. Back Yard/Emergency exists: The main entry door is used for entrance/emergency exit door. LPA observed a locked back gate, exit doors in room #4, room #6, living room and an unlocked side door in the backyard. The pathways were clear of obstruction. No body of water was observed. Patio is covered and furnished with outdoor furniture, appropriate for number of the residents. Resident Files : LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files : LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. Medications : Properly labeled medications were locked in one of the kitchen cabinets. A complete first aid kit and the first aid manual were also observed, together with the medications, in the kitchen cabinet. Medication and Medication Records for four (4) out of four (4) residents were reviewed for proper documentation and administration. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were cited (refer to LIC 809-D). Staff immediately corrected the deficiencies and the administrator will ensure staff are properly trained. Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.