Routine inspection·November 24, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:59 AM. LPA met with facility Administrator Zhanna Davtian. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:01 AM the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: GARAGE: LPA observed the garage to contain two (2) secured cabinets which contained extra cleaning supplies and laundry supplies. LPA observed two (2) secured filing cabinets which contained facility files and resident medications. Additionally, LPA observed the garage to contain the facility’s washer and dryer, extra care supplies, extra linens, and adequate emergency food and water supplies. COMMON AREAS : This includes the living room, entryway, hallway, and dining area. LPA observed the living room to contain adequate seating, a television, and activities for resident use. LPA observed the entryway to contain all required postings and an infection control point with a thermometer. LPA observed a fire extinguisher mounted in the entryway to be fully charged and purchased on 02/24/2025. LPA observed the hallway to be clean and free from any obstructions. The dining area was observed to be clean and properly furnished at the time of the visit. The dining area contained a dining table with adequate seating for resident use. The facility’s combination fire and carbon monoxide alarms were tested at 10:22 AM and were functional at the time of the visit. Continued on LIC 809C. KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives, utensils, and other sharp objects. LPA observed a locked under-sink cabinet to contain cleaning supplies and soaps. LPA observed a complete first aid kit with a first aid manual. BATHROOMS : There are two (2) bathrooms at the facility. One (1) bathroom is designated as a private resident bathroom, and one (1) bathroom is designated as a shared resident bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured between 113.4 and 113.7 degrees Fahrenheit, which is in compliance with regulation. LPA observed both resident bathrooms to contain appropriately secured cabinets which contained personal grooming supplies for resident use. BEDROOMS : There are three (3) bedrooms in the facility; all are designated as dual occupancy rooms. LPA and facility Administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #2 contained a direct exit to the outside of the facility. Auditory alarms were observed on facility exits and all were functional at the time of the visit. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front of the property; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed a total of five (5) window screens on the home to be in disrepair with broken/bent window screen frames. LPA informed the Administrator who agreed to perform required repairs/replacements to the identified screens. RECORD REVIEW: Record review began at 10:34 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed all resident files contained all required documentation and signatures. No deficiencies were observed during record review. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 12:07 PM. Medications for five (5) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 10/06/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) resident and two (2) staff members. The residents interviewed stated that the staff treat them well and are attentive to their needs. The residents interviewed had no concerns with the facility. Both staff interviews were conducted with the assistance of the facility Administrator acting as a translator. Both staff members interviewed understood their roles and responsibilities, the resident’s rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s updated LIC 500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.