Routine inspection·April 18, 2022

Licensing Programming Analysts (LPA) Jewel Baptiste conducted and unannounced visit with focus on infection control, food and medication review. LPA met with caregiver Elmer Manalang and explained the reason for our visit. LPA also spoke to Administrator Tina Arutyunyan and explain the reason for the visit. Facility is licensed to serve 6 over the age of 60 of which 6 is non-ambulatory and 2 can be bedridden. Hospice waiver approved for 2 residents. Facility is a one-story house with a Living room, dining room, kitchen, 4 bedrooms and 3 bathrooms. Facility has multiple fire extinguishers, carbon monoxide detectors with sprinkler system throughout the facility. LPAs and Caregiver toured the facility: Bedrooms #1(R1), #2, #3 and #4 was observed to have all the furnishings of 1 desk, chair, lamp and linens. Bathroom #1 toilet has stains and rings of yellow and brown color. Bathroom #2 shower contained dark stains throughout. Caregiver stated he purchased paint for toilet and tub. Bathroom #3 designated for staff only. Water temperature was tested in Bathroom#1 at 114.6, and Bathroom #2 at 115 , which is within the required 105-120 degrees F. LPA toured the kitchen and observed sufficient food supplies of 7 days non-perishables and 2 days perishable. LPA toured the backyard with caregiver and observed laundry detergent and cleaning supplies place on the floor next to washer and dryer. LPA also observed mattress, box spring and other trash on the side of the house. Caregiver confirmed that theey have tried to get the items removed. Medication was reviewed for Residents #1, #2 #3, #4, #5 and #6. LPA observed 2 of R6 medications empty. Caregiver confirmed medications has been empty for a week and resident usually calls and update his prescription. Deficiencies was observed during this visited and noted on LIC809D, per California code of regulations, Title 22. Exit interview was conducted with Caregiver Elmer Manalang and a copy of this report, LIC809D and appeals rights was provided. Deficiencies was observed during this visited and noted on LIC809D, per California code of regulations, Title 22. Exit interview was conducted with Caregiver Elmer Manalang/ Tina Arutyunyan over the phone and a copy of this report, LIC809D and appeals rights was provided to caregiver.