Routine inspection·July 17, 2024

At 9:45 a.m. Licensing Program Analyst (LPA) Valeria Conway arrived at the facility to conduct the required annual inspection. LPA met with administrator Emma Arutiunian and explained the reason for the visit. At 11:30 a.m. back up administrator Ruzanna Manukyan arrived at he facility and joined the visit. The LPA and the administrator conducted a tour of the physical plant at approximately 10:15 a.m. There are (6) bedrooms for residents and (1) bedroom for staff use only. At 10:52 a.m. smoke alarms and carbon monoxide detector were functioning at time of the visit. The LPA observed all required postings in the entry area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Fire extinguisher was fully charged and purchased in April 11 th 2024. KITCHEN: The kitchen appeared clean and the appliances and fixtures functional during the time of visit, sharp objects are stored in lock box that was kept on the kitchen counter. The LPA observed box to be locked at this time. Some cleaning supplies and disinfectants were observed stored under the sink. The LPA observed the usage of a snap hook carabiner instead of lock. LPA explained Licensee the importance of having a lock to prevent access to cleaning supplies and toxins to residents with dementia. The LPA observed a sufficient amount of perishable and a seven-day supply of non-perishable food at the facility properly stored. Continued on LIC 809-C Continued from LIC 809 BEDROOMS: The residents’ bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate and clean bedding and linens such as sheets, pillowcases, and blankets. During today’s visit LPA observed Resident #1 (R1), a hospice patient, in room #4 unable to reposition in bed, after checking physician report for R1, it revealed that R1 is bedridden. R1 is being retained in a room that does not have bedridden fire clearance. Also, LPA observed two (2) non-ambulatory residents in ambulatory rooms and two (2) ambulatory residents in non-ambulatory room. LPA explained licensee that they all need to be rearrange. Also, licensee will have to communicate with family member and/or responsible parties of these changes. BATHROOMS: The LPA observed all three (3) bathrooms were clean, properly supplied and had functional fixtures. LPA observed grab bars and non-skid mats in the bathroom. Residents have sufficient amounts of supplies for personal hygiene properly stored inaccessible to residents. Between 10:27 a.m. and 10:32 a.m., the hot water was measured in each bathroom during physical plant tour and measured within the required limit of 105-120 degrees Fahrenheit in all three (3) bathrooms. COMMON AREAS: The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Laundry room is located right outside the hallway pass bedrooms #5 and #6. The LPA observed laundry detergent and supplies in cabinets above washer and dryer. Such cabinets were secured with a snap hooks carabiner instead of using a lock. LPA explained Licensee the importance to have these items stored inaccessible to residents with dementia. There is an attached locked garage accessible from the outside and the laundry room. LPA observed garage to store an extra fridge and freezer for perishable foods. Extra medical supplies and furniture was also observed in the garage. Continued on LIC 809-C Continued from LIC 809-C SURROUNDING GROUNDS (Outdoors): LPA observed two (2) non-working vehicles that are obstructing the two (2) pathways leading to the emergency exits. Licensee agreed to have vehicles removed to prevent a potential hazard in case of an emergency. When checking emergency exits, LPA observed a back gate which was shut closed. LPA asked licensee to open the gate, however licensee was unable to so. Licensee agreed to ensure that side gate facing back alley is repaired so it can be opened and closed properly. There was an area with proper furniture for outdoor use in the area located outside of living room to the left of the property for residents to enjoy. There are no bodies of water on the premises. RECORDS: Records review began at 2:00 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Last emergency drill (Fire drill) was conducted on 07/02/2024. MEDICATIONS: Medications review began at 3:12 p.m., medications are centrally stored and locked in a cabinet in the hallway; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medication log. Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 9099-D). Exit Interview Conducted. Failure to correct the deficiencies may result in civil penalties. A Civil Penalty in the amount of $1,000 was assessed during today's visit. Appeal Rights Discussed. A Copy of Report Issued.