Routine inspection·August 30, 2024

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:31 AM. LPA met with facility staff who contacted the facility administrator Emma Kochinyan via telephone call. Facility administrator arrived to the facility at 09:40 AM Entrance interview conducted and the reason for the visit was explained. Beginning at 09:40 AM, the LPA, along with facility administrator 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: KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. The LPA observed the fire extinguisher to be fully charged and purchased on 03/08/2024. LPA observed a secured cabinet and a secured box located in the refrigerator to contain resident medication. BEDROOMS : There are three (3) bedrooms in the facility; all three (3) are designated for resident use. LPA and facility administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom number three (#3) contains a direct exit to the backyard. One resident bed was observed to contain full bed rails. Auditory alarms were observed on facility exits and were functional at the time of the visit. Report Continued on LIC 809-C BATHROOMS : There are two (2) bathrooms at the facility. Both bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in all showers and near all toilets, all were properly secured. The water temperature was measured between 106.5 and 112.3 degrees Fahrenheit, which is in compliance with regulation. Both bathrooms were observed to contain unsecured personal grooming supplies for resident use. COMMON AREAS : This includes the living room, dining room, and a seating area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains an appropriately screened fireplace. Smoke detectors and carbon monoxide detectors were tested at 12:00 p.m. and were functional at the time of the visit. The dining room was observed to be clean and contains adequate seating for resident use. The seating room was observed to be clean with adequate seating and an appropriately screened fireplace. A closet attached to the seating room was observed to be unsecured and contained paint, painting supplies, and a box cutter. OUTDOOR SPACE/GARAGE: The facility has two (2) emergency exit gates, LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. Ramps were observed leading to the backyard from the dining room and bedroom number three (#3). All rails were secure and in good repair. LPA observed an extra refrigerator on the outdoor patio to contain extra food supplies. The garage was observed to be secured and contains a washer and dryer, cleaning chemicals, and extra care supplies. The garage contains adequate emergency food and water supplies. RECORD REVIEW: Record review began at 10:13 a.m. 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, TB tests, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained the required documents. One (1) staff file reviewed was missing the required twenty (20) hours of annual training. Five (5) resident files were reviewed. All resident files reviewed contained all required documentation. Review of resident one’s (R1s) file revealed that they did not have a physician’s order for full bed rails. Report Continued on LIC 809-C MEDICATION REVIEW: Medication review began at 11:33 a.m. Medications are stored centrally and securely in a cabinet in the kitchen. Medications for two (2) residents were observed. Two (2) of two (2) centrally stored medication record sheets were missing some of the resident’s prescribed medications. 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 on 06/03/2024. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated quarterly. INTERVIEWS: LPA interviewed one (1) staff and two (2) residents. All residents interviewed stated that the food was of good quality and is provided in sufficient amounts. All residents stated that staff treat them very well and are attentive to their needs. No residents interviewed had concerns with the facility. The staff member interviewed was knowledgeable on their roles and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s resident roster and liability insurance. The Pursuant to Title 22 of the CA Code of Regulations, and the Health and Safety Code, the following deficiencies were cited (refer to LIC 809-Ds): Citations were issued. Exit interview was conducted. today's report, and appeal rights were reviewed and issued.