Routine inspection·September 17, 2025

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. The LPA was greeted by staff, and staff contacted the Administrator by phone. The LPA spoke on the phone with the Administrator Anait Asatrian and explained the reason for the visit, the Administrator stated it would take them about an hour to get to the facility. The Administrator arrived at the facility shortly thereafter. The LPA and the Administrator arrived at the facility. The LPA 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. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detectors were tested and operational at the time of the visit. The carbon monoxide was not part of the smoke detector, and the facility did not have a carbon monoxide detector. The fire extinguisher was last serviced on 01/15/2024. The LPA observed the required postings throughout the common space. The facility serves residents with dementia, the auditory alarms on the exit doors were not functional at the time of visit. At approximately 10:48 the LPA observed a medication basket sitting on the dining room table which belonged to one of the residents and a bag of medication from the pharmacy also with bottles of medications accessible to residents in care. Continues on LIC 809C...page 2. Staff living area is located in the front of the home. A connecting door between the staff living area and the facility area was observed. The LPA observed it to be unlocked and accessible to residents in care KITCHEN: Knives are stored inaccessible in a kitchen drawer. Kitchen appliances were in operable condition. Kitchen cleaning supplies were observed under the kitchen sink in locked and inaccessible to residents in care. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at….degrees Fahrenheit. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four designated residents’ rooms. Linen closet is located inside bedroom # 4. The closet was observed to be locked at the time of the visit. BATHROOMS: Two (2) bathrooms were observed to be clean and sanitary and in operating condition. First bathroom is located in the hallway; the hallway’s bathroom paper toilet holder was observed to be broken with only one half of the prongs still attached to the wall. Furthermore, the LPA observed cleaning supplies and grooming supplies next to the bathtub and accessible to residents in care, and requires a trash can with tight fitting lid. The second bathroom is a private bathroom which is located inside bedroom #4. The private bathroom needs to have safety grab bars installed. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 119.9 degrees Fahrenheit. LAUNDRY ROOM: A laundry area was observed with unlocked folding doors. A bottle of detergent was observed in an unlocked top cabinet above the washer and dryer and accessible to residents in care. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water noted. A back side gate behind the storage area was observed to be unlocked and the area accessible to residents in care. The Administrator attempted to close the gate, however the gate’s padlock was not working and did not engage. Gate needs to be fixed to close completely and engage lock. Continues on LIC 809C... page 3. Pg 3. RECORDS: Records review began at 12:25 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. Record review revealed that four out of four files were missing some or all of the following: SNP(signatures). No LIC 601/ID, No LIC621- SPV- MA missing Physician contact information. One out of five residents’ file was missing. Per the Administrator the resident was admitted to facility without any personal or medical documentation. At the time of the visit the LPA attempted to communicate with the resident’s family contact, the call was unanswered, and LPA was unable to leave message. Resident’s DOB and last name is unknown. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. One (1) out of three (3) staff files was missing, some or all of the following required forms: LIC 501, 508, 9052, ED, FPCL- Staff works two days per week. MEDICATIONS: Medications review began at 02:05 p.m.; medications are centrally stored and locked in a cabinet in the common area; medications are labeled and were checked for expiration dates. Medications were not properly documented on the centrally stored medications and destruction record form (LIC622). Errors observed during the medication review, as one out of one medication audit indicated that the following medications were not administered as prescribed, where medications were not given daily: Methocarbamol (500 mg/30 count), Benazepril (40mg/30 count), Amlodipine. The LPA requested the following documents: - LIC500 Personnel Report-Was not available for review. - LIC9020 Client Roster-Available- but not completely filled-out. - Liability of Insurance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Administrator was informed of the late license fees due for the facility. Exit interview conducted. A copy of the report and Appeal Rights was issued.