Routine inspection·March 12, 2024

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff Joyce San Pedro, explained the reason for the visit. At 10:00 am Yuliya Asatryan who is the administrator met with LPA, explained the reason for the visit. At 10:57 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 kitchen. The charge date is 12/28/2023. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 6 maybe bedridden; 4 hospice waiver. 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 cabinet in the kitchen. The menu was posted on the refrigerator for review, snacks and beverages are available for the resident in the facility when they want. 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 kitchen, but the storage in the garage is kept unlock , which is accessible to the residents. Bedrooms: There were five (5) bedrooms designated for residents' use. Bedroom #1 is shared, bedroom #2, bedroom #3, bedroom #4, and bedroom #5 is private, the bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are three (3) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 106.1 degrees Fahrenheit for bathroom #1 located in the hallway beside bedroom #5. Bathroom #2 is beside bedroom #4. Hot water temperature was measured at 105.4 degrees Fahrenheit. Bathroom #3 is inside bedroom #1. Hot water temperature was measured at 107.6 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. Fire place is closed, non-operational, and blocked. 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. The garage is attached and was UNLOCK and is used for storage for PPE and cleaning supplies. Citation will be issued in LIC 809-D. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in UNLOCK storage in the laundry area and is located in the garage. Citation will be issued in LIC 809-D 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 by the hallway. 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. Staff is missing LIC 9052 for two staff and the administrator file was NOT reviewed, file is not available in the facility, citation will be cited in LIC 809-D. Continue to LIC 809-C 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 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 current. Resident records were reviewed for requirements and legibility: LPA reviewed client’s files for current plan. Planned activities are offered. LPA reviewed all of residents file and one (1) of the six (6) residents file are missing appraisal. Deficiencies are cited in LIC 809-D. Appeal rights are explained. Exit interview conducted, copy of report has been issued and discussed.