Routine inspection·February 11, 2025

At 10:00 AM Licensing Program Analysts (LPAs), Nadia Shahbazian and Evelin Rios, conducted an unannounced annual inspection at the facility. LPAs met with the staff and explained the reason for the visit. LPA requested the staff to contact the administrator, Narine Hannesyan, who was not in the facility. Later on the staff received a call from administrator’s son, Sam, informing that administrator is unable to meet at this time. Sam provided information and stated the current census is 4. At approximately 10:30 am LPAs conducted a physical plant tour and observed the following: The total capacity of the facility is approved for six (6) residents; LPAs observed four (4) residents. LPAs were informed that resident in room three (3) passed away approximately a month ago. LIC 624A Death Report was not submitted to CCLD. Common Areas : The entry hall was furnished with a dresser. LPAs observed a complete first aid kit in the drawer but there was no first aid manual. LPAs observed three (3) scissors and two (2) sharp nail clippers in an unlocked drawer, accessible to the residents. The living room and dining area is a large space, with the office space in the corner of the dining room. The office area included the telephone for resident use. The living area appeared to be clean and was properly furnished with seating for the capacity of the facility. Continued on LIC 809C The living room has a television set and a fireplace, secured with a screen. LPAs observed a refrigerator in the dining room with a fully charged fire extinguisher on top of the refrigerator. The dining room was equipped with a sliding door which faced a fenced pool and the backyard area but had no stairs, leading down to the outside. The staff informed LPAs that the sliding door does not open, therefore it is not utilized as an exit door. LPAs observed damage on the ceiling of the hallway leading to the bedrooms, in addition the LPAs observed the filter in the hallway to be covered by dust. Currently the main entry door and bedroom #3 and #4 are designated as fire exits but none of the doors were observed to have functional auditory alarms. All exit doors were observed to be free of hazard and obstruction. The facility maintains a comfortable temperature at 73°F. Bedrooms: The facility has four (4) bedrooms in total. All bedrooms were clean, furnished with dresser drawers and chairs with ample lighting and bedding for the residents. Currently no bedroom has been designated for a bedridden resident. Bedroom #1 is private and was in good repair, except for a tear in the window screen. Bedroom #4 is shared currently. Bedroom #2 is private with its own private bathroom. LPAs observed a freezer inside bedroom #2 which included perishable foods for the facility. Bedroom #3 is currently vacant since the resident passed away recently. LPAs observed a bedroom by the dining room currently designated for staff, although the facility sketch designates it as an office and not a bedroom. Bathrooms: The facility had two (2) bathrooms, one shared for residents and the other located in bedroom #2 for private use. LPAs observed grooming items and one razor inside the private bathroom of bedroom #2. All bathrooms contained paper towels and liquid soap. Bathrooms have grab bars and a non-skid floors. Hot water temperature was taken from both bathrooms and was measured between 113.2 and 113.7 Fahrenheit within regulation. Continued on LIC 809C Kitchen: LPAs observed ample supplies and dishes. All knives and sharp objects were observed to be locked in a kitchen drawer. There were ample supply of staple non-perishable food for minimum 1 week and perishable for 2 days at the facility. Laundry: LPAs observed an unlocked shed in the backyard, where the washer and dryer were located. The door of the shed was broken and the laundry detergent/chemicals were accessible to residents. Outside and Back Yard: There was a fenced pool in the backyard. The garage has been converted to a dwelling and is privately occupied. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. Emergency exit gate was kept unlocked and the path was free from debris. Smoke detectors/carbon monoxide . Smoke detectors were located throughout the facility but the one in hallway and in bedroom #1 were dismantled and non-operational. At 11:00 AM, smoke detectors were tested and observed to be operational. Carbon monoxide detectors were not observed. Administrator arrived to the facility to provide records. LPA were unable to review any staff, resident records or medication documentation at this time, due to time constraints. LPAs were unable to complete the annual visit. An unannounced follow-up visit will be conducted at a later date to complete the annual inspection. Deficiencies Cited (Refer to LIC809-D). Exit interview conducted. Appeal rights and copy of report provided to administrator.