Routine inspection·June 19, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 11:38AM. The LPA met with the Licensee Lusine Srmikyan and Coordinating Manager Marine Bekyan and informed them of the reason for the visit. Entrance interview conducted. Beginning at 11:50AM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a single-story residential home on a shared property with another related facility. The following was observed: KITCHEN: The LPA observed knives stored inaccessible in a locked drawer near the sink. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food and water stored in the detached office. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. Grocery shopping occurs every two (2) weeks, sometimes more when needed. Report Continued on LIC 809-D BEDROOMS/RESTROOMS: There are four (4) total bedrooms: Bedrooms #1 and #4 are shared and Bedrooms #2 are #3 are private. Bedroom #4 is cleared for one (1) Bedridden resident and had a direct exit to the outside. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens and supplies were stored in each Bedroom located in cabinets. There are four (4) total restrooms in the facility: three (3) attached private resident restrooms and one (1) common restroom located in the hallway. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 109.6 degrees F and 116.6 degrees F which is within the required range per regulation. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There was an office/staff nook located in the dining area, with required postings and centrally stored medications in a locked cabinet. The facility maintained a comfortable temperature throughout the visit. A fire extinguisher was observed in the dining area and was last serviced on 04/16/2025. There was a laundry closet located in the hallway and contained laundry supplies. The laundry door remains locked when not actively in use and the machines were observed to be operational. Ramps were observed throughout the facility for wheelchairs. OUTDOOR AREA: The surrounding grounds had multiple shaded patio areas equipped with furniture in good condition for resident and visitor use. The front yard had a driveway with a remote operated gate as well as a door for everyday use. There was one (1) emergency exit door located on one side of the facility. The other side of the facility had a locked side gate which contained a shed and general storage/equipment. All exits and passageways were free of obstructions. The LPA observed one (1) shed in the backyard that contained general storage and was locked. The facility had additional gates with access to the neighboring three (3) facilities that the Licensee also operates. Report Continued on LIC 809-D RECORDS: Record review began at 12:17PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 06/03/2025. Smoke and carbon monoxide detectors as well as fire door were tested at 1:53PM and were operational. MEDICATIONS: Medication review began at 1:35PM. Medications are centrally stored and kept inaccessible. Medications were observed for three (3) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Four (4) staff and one (1) resident were interviewed. No complaints noted. Documents obtained: LIC 500 and Resident Roster. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.