Routine inspection·March 19, 2024

Licensing Program Analysts (LPAs) Leslie Ngo-Castaneda and Liezl De La Cerra conducted an annual required visit and inspection of the facility. LPAs was greeted by licensee, Grigor Kosoyan and was explained the reason for the visit. At 11:00 AM, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the entrance. The charge date is 8/31/2023. During the visit the facility is at 74 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 1 bedridden; hospice waiver for 5. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. The menu was posted for review. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the laundry. Bedrooms: There were four (4) bedrooms designated for residents' use. Bedroom #1 and bedroom #3 is vacant, bedroom #2 and bedroom #4 is is shared. Although bedroom #3 is vacant, the room has been used for staff storage. Deficiency will be cited on LIC 809-D. Resident bedrooms were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bathrooms: There are two (2) bathroom at the facility, one for staff and the other one is designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 118.8 degrees Fahrenheit for bathroom #1 located in the hallway beside room #2. Continue to LIC 809-C There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control : Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds : Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does have a swimming pool, this is properly fenced and locked. The garage detached and is used for storage. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the kitchen. Staff Files : LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is located beside the living room by the entrance. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has NOT been logged in the medications log with proper documentation from the clients’ doctor. Deficiency will be cited on LIC 809-D. Continue to LIC 809-C Proper medication dispensing instruction are followed and checked for contamination. Medication was not given to resident for morning dosage. Deficiency will be cited on LIC 809-D. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed client’s files for physician's report, TB test, admissions agreement, personal rights, needs and service plan, and identification and emergency information needs to be done when getting a new resident. Deficiency will be cited on LIC 809-D. Planned activities are offered. Facility is not within CA code of Regulations Title 22 or Health and Safety Code. Citation has been issued on LIC 809-D. Exit interview conducted, copy of report has been issued and discussed.