Routine inspection·May 27, 2021

Licensing Program Analysts (LPAs) Kelly Dulek and Salia Walker arrived at the facility unannounced to conduct a required annual visit at 11:25 AM. This annual had a specific emphasis on infection control practices and procedures. The LPAs initially met with facility staff Karine Khachatryan and discussed the reason for the visit. Administrator Siranush Alvadzhyan arrived at the facility at 1:02PM. The LPAs, along with facility staff Karine Khachatryan, toured the physical plant areas inside and outside at 11:28AM to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. BEDROOMS: The LPAs observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 3 (three) total resident bedrooms. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. LPAs observed sufficient amounts of soap and paper products in each restroom. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common area and dining room furniture was observed to be in good condition. The LPAs observed the required postings in the common dining room and hallway. One fire extinguisher was observed to be fully charged and purchased on 2/14/2020. The yard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. At 12:22PM, LPAs observed an outdoor shed, containing Hot Shot Bug Killer, Comet, Easy Off, Ant & Roach Killer, Fabuloso floor cleaner, and Round Up spray, among other chemicals, was unlocked and accessible to residents in care. At 12:23PM, LPAs observed 2 (two) lighters and 2 (two) packs of cigarettes on the outdoor seating area, accessible to residents in care. Report Continued on LIC 809-C KITCHEN : Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. RECORD REVIEW : At 12:10PM, LPAs reviewed resident records for, but not limited, to the following: physician's report and needs and service appraisal. At 12:13PM, LPAs observed Resident #1 (R1) who according to the Administrator has a diagnosis of dementia, did not have a physician's report on file. R1 moved into the facility in June of 2020. INFECTION CONTROL: During today’s visit, the LPAs spoke with the facility staff regarding the facility’s infection control practices at 11:35AM. Upon entry, the facility has a central entry point for symptom screening. The LPAs observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. The following recommendations were made: - Post PINs and educate staff, residents, and families on changing policies and procedures from the Department - Staff surveillance testing should be completed per PIN 20-38-ASC Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted, today's reports, appeal rights were reviewed and emailed to the Administrator.