Routine inspection·March 30, 2022

Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced visit for the purpose of an annual required. LPA met with S1 and S2, an explained the purpose of today's visit. At 10:15 Administrator Arutyunyan arrived and assisted with the remainder of the visit. Upon arrival LPA checked association and observed S2 not on the association list. S2 confirmed that she has worked here for a week. Facility is licensed to serve 6 over the age of 60. 6 of which is non-ambulatory, and 1 can be bedridden. Hospice waiver approved for 4 residents. Facility is a one-story house in a residential area. LPA made a complete tour of facility which included: 6 bedrooms, 2 bathrooms, living room, kitchen, dining room, laundry area, outdoor area, and garage. Administrator certificate #6002858740 expires 4/5/2023. The following was observed, reviewed, and inspected: Bedrooms #1-5 are designated for residents. Bedroom #6 is designated for staff. Each bedroom contained the required furniture and linens as mandated. Bathroom was observed to contain working fixtures, and were equipped with necessary grab bars. Resident bathroom was missing non-slip mat. Water temperature measured in the residents bathroom at 123.6 degrees F, which is not in the required range of 105-120 degrees F. Kitchen was inspected and no deficiencies observed; cleaning materials and knives were secured in a locked cabinet, appliances were clean and operational, and an adequate supply of 2 days perishable and 7 days non-perishable. LPA observed sufficient linen,required documents were posted in the office area, trash cans with tight fitting lids. Smoke detector and carbon monoxide detectors were tested and operable, fire extinguisher(s) fully charged, front and back yard clean and free of debris. Staff files for administrator, S1 and S2 was reviewed. Administrator stated S2 do not have a file yet because she is newly hired. Medication for all residents was reviewed. The last disaster drill was conducted on March 4th 2022 . Report continued on 809C Pursuant to Title 22 Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Civil penalties issued/ Exit Interview Conducted / Appeal Rights provided / A Copy of the Report Issued.