Routine inspection·May 20, 2021

Licensing Program Analyst (LPA) Naira Margaryan arrived to the facility to conduct unannounced REQUIRED -1-YEAR INSPECTION. LPA met two facility staff and they assisted LPA during this visit. At 12:55pm, LPA Margaryan spoke with the Administrator over the phone and explained the purpose of this visit. At 1:00pm, LPA Margaryan inspected entire facility inside and out. LPA inspected the residents bedrooms, bathrooms, living room, dining area, kitchen and food supply. In addition, LPA observed and assessed all five (05) residents residing in the facility. At the time of this visit the facility retained one hospice resident. Upon inspection, LPA observed the bed located in the large storage room and was informed that the storage space is being used as a staff bedroom. Both staff members were staying at the facility and the second staff was sleeping on the sofa located in the office area adjacent to the kitchen. Front yard and backyard was inspected and there clear from obstruction. The facility mitigation plan and Emergency evacuation plan was discussed during this visit. The Administrator was advised that no storage space or common area can be used as a sleeping quarter for the caregivers and if facility does not have designated room for the staff, than they should have awake night shift staff. Under Title 22 Division 6, Chapter 8, following citation was issued and recorded on LIC809D. No immediate health and safety hazard is noted during this visit. Exit interview was conducted and a copy of report was issued.