Routine inspection·October 12, 2024

On 10/12/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with house manager Rowena Bacucang and explained the purpose of today’s visit. Bucucan contacted administrator Tina Arutyunyan by telephone who was not able to be present for this visit. The facility is licensed to operate for six (6) non-ambulatory of which (1) may be bedridden. The facility is approved for (4) hospice residents. Currently, the facility has (4) residents in hospice care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident's rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, an outside patio area, and garage used for storage. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 109.0-degree F. A comfortable temperature of 73 degree was maintained in the facility. LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. A review of the Medication Administration Record (MAR) was maintained in order. The facility has conducted a disaster drill on 07/14/24. A landline telephone was in working condition. A review of staff CPR/First Aid training is current. Evaluation Report Continues LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. The facility is current on Community Care Licensing annual dues. An audit of residents #1-#6 (R1-R6) service files and staff #1-#4 (S1-S4) personnel files revealed to be complete. The facility has the current administrator's certification on file for Akop Ekmyan #7001640740 exp. 07/31/25. DEFICIENCIES: Resident room #4 is missing a window screen. Resident #4 is diagnosed with Dementia and (4) residents on hospice with no night shift "awake" staff. (2) stove burners and oven non-operable. Kitchen walls, ceiling and exhaust fan full of grease is unsanitary. Bathroom faucet and toilet flusher loose/not tight fitting require repair. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 809-D). An exit interview conducted with Rowen Bucucang, a copy of report and appeal rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *