Routine inspection·June 16, 2025

On 06/16/2025 Licensing Program Analyst (LPA) Evelin Rios, arrived to the facility listed above to conducted an unannounced annual visit. Upon arrival LPA was greeted and granted access by staff. Staff contacted the administrator and informed them LPA was at the facility. In the facility LPA observed (03) three staff and three (03) residents. LPA met with the house manager, Mikayel Gurokyan shortly after. LPA explained the reason for the visit. This is a Residential Care Facility for the Elderly vendored by Lanterman Regional Center. At approximately 10:20 a.m, LPA conducted a physical plant tour of the facility and observed the following: At entrance on the first hallway leading to residents' bedrooms, LPA observed appropriate postings such as personal rights, the facility's Emergency Disaster Plan and facility sketch. Common Areas: These include the living and dining area. Common areas were checked for cleanliness and condition. The living room and dining area were observed clean and clear of clutter. The facility maintains a comfortable temperature at 72°F. LPA did not observe any tripping hazards. The furniture was observed clean an in good repair. Seating was sufficient for the capacity of the facility. Bedrooms: LPA observed a total of three (03) bedrooms designated for residents' use. Resident bedrooms are shared. Resident bedrooms were observed clean and clear of clutter, properly furnished with appropriate beds, night stands and chairs. LPA observed sufficient storage for residents. (continued on LIC 809-C) Bathrooms: There are two (02) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. At 10:47 a.m., LPA took the hot water temperature from one (01) out of two (02) bathrooms and it measured 114 degrees Fahrenheit, within regulation. Outside/Surrounding Grounds : LPA observed that the entry/exits were free of obstruction. There is a shaded area for residents to use and furniture appropriate for outdoor use. The backyard is sufficient in space for outdoor exercise and activities. The facility has a detach garage. In the garage LPA observed a washer and dryer. LPA also observed cleaning products, detergent, emergency food and an extra refrigerator to store an over flow of food for residents. Food Service/Kitchen: In the kitchen LPA observed the kitchen to be clean and clear of clutter. Appliances and fixtures were functional. LPA also observed a 7 day supply of non-perishable amount of food and a 2 day supply amount of perishable food in the facility, properly stored. Dual smoke/carbon monoxide detector are hardwired and interconnected, and were tested by the house manger at 10:48 a.m. and observed to be operational. There is a fire extinguisher in the facility located in the kitchen. Fire extinguisher was observed to be fully charged with purchase date 01/28/2025. Resident records : Six (06) of six (06) resident records were reviewed and observed to be complete and up-to-date. Medications : LPA observed medications were locked and kept in a hallway closet inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Facility also keeps a Medication Administration Record (MAR). There is a complete first aid kit located in the medication closet. Staff records : Three (03) staff files were reviewed for compliance and current training. Staff records were observed complete and up-to-date. LPA reviewed facility records and observed the facility had an earth quake drill on 06/02/2025, fire drill on 05/01/2025 and last reviewed their Infection Control Plan on 04/02/2025. No deficiency cited during today’s visit. Exit interview conducted and copy of this report provided.