Routine inspection·February 3, 2025

At 9:30 AM Licensing Program Analysts (LPAs), Huma Rahimi and Nadia Shabazian, conducted an unannounced annual inspection at the facility mentioned above. LPAs met with the staff Anahit Zohrabyan and later Administrator Sofya Khechikyan arrived and explained the reason for the visit. Physical tour was conducted with the Administrator and LPAs observed the following: The total capacity of the facility is approved for six (6) residents; however, LPAs observed seven (7) residents. LPAs were informed that one (1) of the residents is their family member. Kitchen: At 9:45 AM LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen drawer. LPAs observed a fully charged fire extinguisher hanging on the wall by the kitchen purchased on 02/03/2025. Medications: At 9:50 AM LPAs observed medications are centrally stored and locked closet in a hallway. Additionally, LPAs observed Hydrocortisone Ointment 2.5% in the kitchen drawer unlocked and as well as other medication and ointments in residents bedrooms unlocked and accessible to residents in care. Furthermore, at 2:30 PM, during the medication review for six (6) out of six (6) residents, LPAs could not verify the accuracy of the medication administration due to the lack of incomplete Centrally Stored Medication Destruction Form. Administrator informed LPAs that the Administrator did not complete the form and was unable to provide a reason. Bedrooms: The facility has six (6) bedrooms in total. All bedrooms were clean and odorless. Furniture was in good repair. Bedroom #3 was designated for a bedridden resident, and the emergency exit was free from obstruction. Bedroom #6 is shared and one of the resident is a family member of the Administrator who requires full assistance with daily living. One of the bedrooms located near the kitchen is designated for staff and LPAs observed free of hazard and obstruction. LPAs also observed medication accessible to residents in their bedrooms. Continue on LIC 809C Bathrooms: The facility had 3 bathrooms. Bathrooms #1 located by the entrance is designated for staff and LPAs observed a small cabinet with an Antibiotic Pain Ointment and Vicks accessible to residents in care. All bathrooms contained paper towels and liquid soap. Bathroom #3 attached to bedroom #6 has a trash can without tight fitting lid and as well LPAs observed scissors accessible to residents in care. Bathrooms have grab bars and a non-skid mat. Hot water temperature measured at 119.8°F. Common Areas : The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Garage: LPAs entered an unlocked garage and saw more cleaning supplies, hazardous liquids, detergents, and extra PPE accessible to residents in care. LPAs observed an extra refrigerator for staff. Laundry: The laundry is located between the kitchen and garage. LPAs observed an unlocked laundry detergent accessible to residents in the laundry room. Staff admitted to LPAs that they forgot to lock it away after using it this morning. Outside and Back Yard: LPAs toured the two side paths and back yard. Both emergency exit gates were unlocked, and paths were free from debris. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. LPAs observed gardening tools and a full can of paint accessible to residents in care. Smoke detectors/carbon monoxide . Smoke detectors were located throughout the facility, and at 10:00 AM, they were tested and observed to be operational. Carbon monoxide was living room and was also tested and observed to be operational. LPAs heard functioning auditory alarms on all exit doors. Between 12:00 PM to 2:30 PM, LPAs reviewed records of four (4) residents and two (2) staff. Resident files were not updated/completed. Staff records and training were not updated and completed. . During the interview with the Administrator LPAs were informed that one of the residents (R5) passed away on 09/05/2024. On or about 09/01/2024, R5 was taken to the hospital due to breathing problem and R5 passed away in the hospital. LPAs reviewed all incident and death reports in the system and did not observe any Incident or death reports regarding R5. Continue on LIC 809C In addition, the Administrator admitted that no incident or death reports were submitted to the Regional Office (RO) since the Administrator forgot to submit an incident and death reports to the department. Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. Deficiencies cited during today’s visit. Appeal rights issued and given. Exit interview conducted and copy of this report signed and delivered. Administrative: LPAs collected Certificate of Liability Insurance, and LIC500.