Routine inspection·May 12, 2025

Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff, Herman Ledesma, and explained the reason for the visit. Administrator Tina Arutyunyan had arrived later to the facility. At approximately 10:00 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. LPA observed dual smoke and carbon monoxide detectors were located throughout the facility, and they were tested and observed to be operational. The fire extinguisher is located in the kitchen. The purchase date is September 24,2024. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food sealed and properly stored. Knives were stored in a locked drawer. LPA observed medications are centrally stored and locked in a kitchen cabinet and inaccessible to residents in care. Bedrooms: There are five (5) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational . Staff bedroom is located by the living room. Bathrooms: There are three (3) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 106.7 F. No cleaning supplies were observed in either bathrooms during the day of the inspection. Common Areas : These included the living room, family room and dining area. The common areas were properly furnished. The dining room table is large enough to sit the capacity of the facility. Seating such as couches where in good repair and sit the capacity of the facility . (Continue on 809C) Surrounding Grounds : The backyard was large enough to hold outdoor activities. LPA checked the side gate to insure no locks installed, and that it is clear to exit/evacuate in case of an emergency. The outdoor area was free of hazards. Staff Workstation/Office : There is a staff workstation located at the corner of the living room. Laundry area : The laundry area is located adjacent to the garage. No cleaning supplies or detergents present during inspection. Cleaning supplies and detergents are kept in the garage, that has a locked entry. Garage: The garage is attached to the building. It is used for storage space to keep cleaning supplies and detergents. Entry to garage is kept locked at all times. Resident Files : LPA conducted a file review of resident records to ensure compliance with licensing forms. LPA observed that R2 has half rail without a written order from a physician indicating the need for the postural support . LPA also observed that R4 and R5 have no updated physician report (LIC 602). Administrator was advised to provide the requested documents promptly. Staff Files : LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Medications : Medications are stored in a locked cabinet in the kitchen. Medication and Medication Records were reviewed for proper storage and documentation. Exit interview conducted, citations issued, appeal rights given and copy of the report delivered.