Routine inspection·October 23, 2024

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA was greeted by staff Armine Kiseleva and was advised for the reason of the visit. At 10AM Mariam Balasanyan who is the administrator met with LPA, explained the reason for the visit. At 9:30 AM, with the assistance of staff, 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 dining room, bedrooms and hallway. The charge date is 9/25/2024. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; hospice waiver six (6). 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 drawerin the kitchen. 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 locked away in the kitchen. During the tour, LPA found over-the-counter medication in an unlocked drawer in the kitchen and accessible to residents. Deficiencies will be issued in LIC 809-D. Bedrooms: There were six (6) bedrooms designated for residents' use. Bedroom #1, bedroom #2, bedroom #3 (vacant), bedroom #4 (vacant), bedroom #5 and bedroom #6 are for private used, all of the bedrooms that are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. During physical plant tour LPA noticed PRN, medications and supplements were seen in their residents bedrooms, deficiencies will be cited on LIC 809-D. Continue to LIC 809-C Bathrooms: There are two (2) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 119.8 degrees Fahrenheit for bathroom #1 located in the hallway beside room #1. Bathroom #2 is inside bedroom #3. Hot water temperature was measured at 119.7 degrees Fahrenheit. 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 not have a swimming pool or body of water. Facility has no garage, but just a car port. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a unlocked cabinet in the laundry area located in the backyard. Cleaning supplies were also seen on the floor that was kept unlock that is accessible to the residents. Deficiency will be cited on LIC 809-D. Staff Files : LPA conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is in the living room. 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. Continue to LIC 809-C Medications are in a centrally stored but not in a locked place, LPA found staff medication, residents PRN, medications, and supplements in the living room and the bedrooms of the residents. Medications including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been not been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: Planned activities are offered. LPA reviewed all of the resident files and is complete. Facility is NOT within CA code of Regulations Title 22 or Health and Safety Code. Deficiencies were found, this will be cited on LIC 809-D. exit interview conducted, copy of report has been issued and discussed.