Routine inspection·March 20, 2024

Licensing Program Analyst (LPA) Valeria Conway arrived at 9:28 a.m. to conduct an unannounced Annual visit. The LPA was greeted at the door by staff, Lilit Grigorian. The Administrator, Mariam Kevliyan arrived shortly after at 9:36 a.m. and was explained the reason for the visit. At 9:55 a.m., The LPA toured the physical plant areas with staff to ensure client health and safety and to ensure the facility is in compliance with Title 22 regulations. The following was observed: Hardwired combination smoke and carbon monoxide detectors were tested at 10:52 a.m. and were functional at the time of the visit. Fire extinguishers were observed throughout the common areas and were fully charged and last serviced 12/27/2023. KITCHEN: The LPA observed the kitchen/dining area to be clean and kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The LPA observed the kitchen refrigerator to be fully stocked at the time of visit. Knives and sharps are locked in a drawer at the kitchen island. Hot water temperature measured at 111.9 degrees Fahrenheit at 10:10 a.m. LPA observed soaps, detergents, cleaning compounds or similar substances to be locked and stored under the sink, however LPA observed cooking oil under the sink and explained to the administrator that cleaning supplies shall be in areas separate from food supplies. Continued on LIC 809C Continued from LIC 809-C BEDROOMS: There are (4) four bedrooms designated for resident use and (1) one bedroom designated for staff use. Staff bedroom is located adjacent to the kitchen. Bedroom #3 and Bedroom #4 have a direct exit to the exterior. The facility has furnished each room with clean linens, appropriate furnishings, and sufficient lighting for resident use. RESTROOMS : Resident bathrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. The LPA observed signs in all bathrooms promoting good hand hygiene. Bathroom hot water measured between 118.6 and 119 degrees Fahrenheit during the time of the visit. COMMON SPACES: The LPA observed the living room area which is clean and properly furnished with seating, and a television for resident use. The LPA observed three (3) residents in the living room watching television during time of visit. Flooring was checked for cleanliness, all areas were clean, sanitary and in good repair. The LPA observed cameras in all common spaces and a screened fireplace in the living room. LAUNDRY/STORAGE ROOM: Washer, dryer and laundry supplies were observed inside the locked storage room inaccessible to residents. Also, emergency food, emergency water, extra disposable cutlery, first aid kit was observed to be complete including a manual. Additional incontinent supplies were observed in the locked laundry/storage room adjacent to the kitchen. At the moment, Administrator is upgrading cabinets in the storage room and an amount of carton boxes and harmless debris is on the side of the facility. These items are not obstructing any main exit/emergency route however Administrator agrees to clean it up right away. OUTDOOR AREA: The LPA observed a covered patio area with patio furniture including a table and chairs for resident use. Facility has one (1) fence gate that self-latches with clear passageways for emergency exit use. There were no bodies of water accessible to residents at the time of visit . Continued on LIC 809-C Continued from LIC 809C GARAGE: The facility does not have a garage. Emergency food supplies and additional incontinent supplies were observed in the locked laundry room adjacent to the kitchen. MEDICATION & OFFICE AREA: Medications were observed in a locked filing cabinet in the office area adjacent to the kitchen. Medication cabinet is always locked, and inaccessible to clients. At 12:30 p.m., medications were reviewed for four (4) clients. Medications observed were properly labeled and in compliance with regulation. At this time, medications reviewed were not logged on the centrally stored medication record. Administrator is using pharmacy medication list which it does not include all required information. LPA advised administrator to use form LIC622 (Centrally Stored Medication Record). STAFF/CLIENT FILE REVIEW/INTERVIEWS: LPA reviewed six (6) staff records during today's visit. LPA reviewed four (4) client file records during the visit. All staff and client records reviewed were in compliance with Title 22 regulation at the time of the visit. During today's visit, LPAs interviewed 3 (three) clients and 2 (two) staff. INFECTION CONTROL/DISASTER PREPAREDNESS: During today’s visit, the LPAs reviewed the facility's infection control policy and disaster preparedness policies. LPA communicate to Administrator that new version of the Emergency Disaster Plan for Residential Care facilities for the elderly is required. LPA printed new revision form and was given to Administrator to complete and post and explained that it needs to be yearly reviewed or updated if any changes occurs. All items reviewed were in compliance. Last emergency drill was completed on 12/15/2023. Exit interview conducted. No citations issued. A copy of the report was issued.