Routine inspection·April 3, 2025

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility to conduct an unannounced required annual visit. LPA was greeted by staff who called the Licensee and the Administrator. The Licensee, Nino Gelashvili and Administrator Gohar Ambartsumyan arrived shortly thereafter. LPA Urena explained the reason for the visit. The LPA and the Licensee 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. KITCHEN: Knives are stored in a locked drawer next to the stove. Kitchen appliances were in operable condition. The refrigerator and freezer need a thermometer to monitor the temperatures. The facility has a sufficient supply of perishable and non-perishable food. Cleaning supplies were observed on top and under the kitchen sink unlocked and accessible to residents in care. Staff locked the cabinet door at the time of the visit. Hot water in the kitchen sink faucet measured at 115.8 degrees Fahrenheit (F). The LPA observed medications (insulin injections) located in the door area of the refrigerator and the freezer, and not locked in a secured box. The medications were accessible to residents in care and pose an immediate danger to residents in care. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. Cameras were observed at the time of the visit; however, Licensee stated that they are not working at the moment. Smoke detector and carbon monoxide were tested at 12:10 p.m. and operational at the time of the visit. The fire extinguisher was fully charged and last purchased on 04/14/2024. Exits have functioning auditory devices, however, at the time of the visit they were not activated. The licensee activated them at the time of the visit. The LPA observed required postings throughout the common space, however the CCL poster, “If you see something, say something” poster was missing at the time of the visit. Licensee stated that one of the residents probably took it down. The Licensee post it in a location where it won’t be removed by residents in care. The laundry room is located next to the kitchen area. The side door leading to the hallway was observed to be unlocked at the time of the visit. Bedrooms: Had appropriate furnishings, and sufficient lighting. The LPA observed shared bedroom #4 to have a fireplace which had a cover and a painting in front of it. The LPA observed boxes of items stored in the corner of the room. The Licensee stated that staff are cleaning the garage, and they stored the boxes temporarily in the room. The LPA explained to the Licensee that the bedroom cannot be used for storage, even temporarily. The Licensee stated that they will remove the boxes as soon as possible. There was a linen closet in the hallway with extra towels and linens. RESTROOMS: The two (2) resident restrooms appeared clean and sanitary. The toilet in the hallway bathroom was not in operating condition at the time of the visit. The Licensee stated that the private bathroom in bedroom #4 had paper disposed in it, making the toilet in the hallway to get backed up, consequently the staff had to shut off the water in the toilet to prevent it from backing up. The toilet seat was observed to be loose, causing a potential hazard for the residents in care. The Licensee asked a handy person to fix the toilet while the LPA was conducting the annual inspection. At the time of the inspection the LPA did not observe a non-skid mat available in the tub. The Licensee stated that staff remove the mat when the residents are not being showered or given a bath. The private bathroom’s shower was observed to have a shower chair in disrepair, and in not useable condition. The Licensee stated that residents/staff do not use the shower seat, but that they had kept the seat to use as a sample to order a new shower chair, which they had already ordered. The LPA advised the Licensee to throw away the shower seat. The shower chair poses a potential hazard to residents in care. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured at 116.2 degrees Fahrenheit. OUTDOORS: The backyard has an outdoor area for residents’ use, however at the time of the visit the LPA observed the shaded area to be in disrepair due to the shade fabric (patio umbrella and canopy) being torn. The Licensee stated that the fabric was torn in the last few months. The LPA advised the Licensee to replace the shade items. The outdoor furniture was observed to be piled up together, preventing use of it. The licensee will work on the seating/shaded area to make it available for residents’ use. The facility has a side gate that self-latches with no obstructions in case of an emergency at this time. There were no bodies of water noted. LPA observed a sufficient amount of space for activities. There was a detached garage located on site. LPA observed garage to store extra furniture and medical supplies at this time. Emergency water was stored in the garage. RECORDS: Records review began at 1:05 p.m., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate annual training. All files were in order. MEDICATIONS: Medications are centrally stored and locked in a cabinet in the laundry room area, however at the time of the visit the LPA observed the medicine cabinet to be unlocked and accessible to residents in care. The Licensee stated that the key had broken inside the lock and the staff informed of the incident today in the morning. The Licensee stated that the lock will be replaced. Furthermore, the LPA observed a bottle of medication (Risperidone), the bottle contained two pills inside, located inside the laundry cabinet which was also unlocked. The LPA observed medications (insulin injections) located in the door area of the refrigerator and the freezer, and not locked in a secured box. The medications were accessible to residents in care and pose an immediate danger to residents in care. Medications review began at 2:29 p.m.; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. However, the LPA observed errors during the medication audit. The medication Trazodone (50mg./30 pills) was observed to have an inaccurate amount of pills, when compared to the Centrally Store and Destruction Record (LIC 622) information. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster-Licensee will add the name of the Clinic/physician for each resident in the list. - Certificate of Liability of Insurance (expired 04/01/2025), Licensee will email LPA a picture of a valid certificate. _ Emergency Drill Logs 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. Failure to correct the deficiencies may result in civil penalties. Citations were issued at this time. Exit interview. A copy of the report was issued, and Appeal Rights were issued.