Routine inspection·October 19, 2022

Licensing Program Analysts (LPA) Evelin Rios conducted an Annual Required visit and inspection of the facility. LPA was granted access by staff Mariam Bejanyan and the administrator, Kristine Dovlaytan met us shortly after and LPA explained the reason for the visit. At 12:00pm, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detectors are dual an they are interconnected. The fire extinguisher is located by the living room, next to the kitchen. It is inspected every year last inspection on tag date is 3/09/2022. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked cabinet in the kitchen. Cleaning supplies also stored in and kept locked and inaccessible to the residents in kitchen cabinet. Bedrooms: There were three (3) bedrooms designated for clients' use. All three bedrooms, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for clients' use. One (1) bathroom out of two (2) located in resident's room is designated for private use was properly supplied and had functional fixtures. Second bathroom was designated for all residents was properly supplied and had functional fixtures. Hot water temperature was measured between 117 degrees Fahrenheit. Common Areas: These included the living room, dining area and laundry area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Properly labeled medications were locked in a cabinet in the kitchen area. LPA observed One (1) out of five (5) resident’s refill medication was kept in a cabinet in the unlocked garage with access through the kitchen accessible to residents with Dementia. The laundry room is located by the kitchen and detergents and cleaning supplies are kept locked in a cabinet laundry room. Cleaning supplies also stored in the laundry area were kept locked and inaccessible to the residents. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. LPA observed a back-house with different address that is not part of facility. Side gate on the side of the home that leads to the front yard was closed but not locked and available for use in case of an emergency. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. LPA observed One (1) out of the five (5) resident's files was missing a medical assessment / physician's report in file. Administrator could not produce the document on day of visit. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were review for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed during the visit. Exit Interview Conducted / Deficiencies cited noted on 809D / Appeals Rights discussed/ Copy of the Report Issued .