Routine inspection·July 24, 2024

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 08:53 AM. LPA was greeted by Facility staff who contacted the facility administrator Alin S Papazian. Facility administrator arrived to the facility at approximately 10:00 AM Entrance interview conducted. Beginning at 08:58 AM, the LPA, along with Facility staff 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: COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. Cameras were observed in the common areas staff stated that the cameras record audio. A properly screened fireplace was noted in the living room. The LPA observed the fire extinguisher to be fully charged and purchased on 07/05/2024. Smoke detectors and carbon monoxide detectors were tested at 09:37 AM and were functional at the time of the visit. KITCHEN & LAUNDRY : The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days perishable and two (2) days non-perishable food and emergency water. The LPA observed one designated cabinet where knives and sharps are stored locked and inaccessible to residents. At 9:05 AM LPA inspected the refrigerator which was observed to contain expired milk. LPA observed moldy vegetables stored on the kitchen counter that were discarded promptly. The laundry is located in a closet attached to the kitchen. Laundry supplies were observed to be in a locked cabinet inaccessible to residents in care. Report Continued on LIC 809-C Continued from LIC 809-C BATHROOMS : There are three (3) bathrooms for resident use, one (1) of which is a private resident restroom located in bedroom three (3) and two (2) are shared resident restrooms. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured between108.7 and 118.4 degrees Fahrenheit, which is in compliance with regulation. BEDROOMS : There are four (4) bedrooms in the facility; all are designated for resident use, including two (2) shared rooms, All 4 (four) resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Cameras were observed in resident rooms. The closet light in resident bedroom three (3) was observed to be nonfunctional at the time of the visit. OUTDOOR SPACE: The backyard has sufficient patio furniture including a table and chairs for resident use. Facility has one exit gate that was observed at 09:34 AM to be locked and failed to self-latch, LPA observed clear passageways for emergency exit use. LPA observed ongoing construction in the backyard. GARAGE : The entry to the garage was observed to be locked and inaccessible to residents. Laundry supplies and chemicals are stored in a cabinet. Garage contained adequate emergency food and water supplies. LPA observed expired emergency food supplies that were discarded at the time of the visit. RECORD REVIEW: 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, and personal rights. LPA reviewed employee trainings and observed the training logs to lack the number of hours completed for each training. MEDICATION REVIEW: Began at 11:45AM. Medications for 2 (two) of five (5) residents were observed. All medications reviewed were documented and no deficiencies were observed during medication review. Report Continued on LIC 809-C Continued from LIC 809-C 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 it pertains to infection control are adequate. Last emergency disaster drill was conducted 06/01/2024. The facility’s emergency disaster plan was outdated at the time of the visit and requires revision. INTERVIEWS: LPA interviewed two (2) staff and one (2) residents. 2 (two) out of 2 (two) residents stated that there were not enough activities for them to participate in at the facility. Both staff were knowledgeable on their roles and responsibilities. The following deficiencies were observed (See LIC 809-Ds) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Licensee was advised that failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.