Routine inspection·May 5, 2025

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two (2) staff and four (4) residents present. The LPA was greeted by staff who then contacted the Administrator via telephone. The Administrator, Siranush Alvadzhyan arrived at approximately 11:00 a.m. and at this time, the reason for the visit was explained. Entrance interview conducted. Starting at 11:03 a.m., the LPA along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA inspected the kitchen/food service area at 11:10 a.m. Knives and sharps were observed in locked metal containers on the kitchen counter. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be new and fully charged with a purchase date of 04/30/2025. Report Continued on LIC809C... Report Continued from LIC 809... Required postings were observed throughout the common space. Activities were observed in the living room and dining room. There is a working telephone on premises. The LPA observed a locked closet in the hallway with additional clean linens, towels, and personal hygiene items. Laundry room was observed locked and inaccessible at the time of the visit. Cleaning supplies and detergents were observed inaccessible to residents in care at the time of the visit. RESTROOMS: There are two (2) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 11:05 a.m., the hot water temperature was measured in both bathroom and they measured within the required range of 105 – 120 degrees Fahrenheit. BEDROOMS: There are three (3) bedrooms for resident use. All bedrooms are designated as double occupancy / shared rooms. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. BACKYARD: The backyard has a covered patio area with patio furniture for resident use. The LPA observed two (2) locked sheds for storage purposes. All passageways were observed to be clear of any obstructions. The facility is gated. No bodies of water noted at the time of the visit. RECORDS: The LPA reviewed Resident Records at 11:30 a.m. and Personnel Records at 12:05 p.m. Four (4) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All files were in order. Report Continued on LIC 809C... Report Continued from LIC 809C... Six (6) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All records were in order. Administrator’s certificate is valid until 03/19/2026 INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; the last one conducted on 04/28/2025. MEDICATIONS: Medications review began at approximately 01:00 p.m. The medications are locked in a cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appeared to be given as prescribed at the time of the visit. No citations issued. Exit interview conducted. A copy of the report was provided.