Routine inspection·October 2, 2025

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:44 AM. LPA met with facility staff who contacted the facility Administrator Anna Atayan. The Administrator arrived to the facility at 10:09 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:10 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: KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed two (2) secured cabinets to contain resident medication. Additionally, LPA observed the kitchen to contain sufficient emergency food supplies, the facility’s washer and dryer as well as the facility’s first aid kit. LPA observed a camera in the kitchen area. LPA confirmed with the facility Administrator that audio is not recorded. GARAGE: LPA observed the garage to be locked inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, emergency water supplies, and an extra refrigerator. Additionally, LPA observed the garage to contain a couch and a bed for staff use. Continued on LIC 809C. COMMON AREAS : This includes the living room, hallway, and dining room. LPA observed the living room to be clean and in good repair. The living room contained adequate seating and activities for resident use. LPA observed a fire extinguisher mounted in the living room to be fully charged and purchased on 02/24/2025. LPA observed a hallway closet to contain extra linens. LPA observed the dining room to be clean and properly furnished at the time of the visit. The dining room contained a dining table with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms, as well as the facility fire door, were tested at 01:16 PM and were functional at the time of the visit. BEDROOMS : There are five (5) bedrooms in the facility; one (1) is a dual occupancy room and four (4) are single occupancy rooms. LPA and facility Administrator toured all five (5) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. BATHROOMS : There are four (4) bathrooms at the facility. Three (3) bathrooms are designated as private resident bathrooms, and one (1) bathroom is designated as a shared resident bathroom. All 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 resident toilets, all were properly secured. LPA observed the shared resident bathroom to contain appropriately secured cabinets which contained personal grooming supplies for resident use. The water temperature was measured between 117.3 and 118.0 degrees Fahrenheit, which is in compliance with regulation. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the outdoor deck to be connected to the facility hallway and bedroom#4 and bedroom #5. All railings on the deck were properly secured. LPA observed cameras in the outdoor spaces of the facility. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:37 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 all required documents and trainings. Six (6) resident files were reviewed all resident files contained all required documentation and signatures. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 12:50 PM. Medications for three (3) of six (6) 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 09/17/2025. 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) residents and two (2) staff members. Both residents interviewed stated that the staff treat them well and are attentive to their needs. Both residents had no concerns with the facility. One (1) staff interview was 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 LIC 500, resident roster, and liability insurance. No deficiencies were observed during today’s inspection. Exit interview conducted and copy of the report was issued.