Routine inspection·February 28, 2024

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. LPA Urena was greeted by staff and explained the reason for the visit. Staff called administrator Emma Avetisyan on the phone, and the LPA explained the reason for the visit. LPA communicated with Administrator via cell phone. LPA Urena and staff conducted a tour of the inside and outside the facility to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 70 degrees. The LPA observed required postings throughout the common space. KITCHEN: Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. The freezer and refrigerator are stocked with a variety of foods. The emergency food supply is adequate for six residents and two staff. The laundry room is equipped with a functioning washer and dryer. The room was locked at the time of inspection. One fire extinguishers were fully charged and were last serviced/purchased on 02/26/2024 BEDROOMS: Bedrooms were furnished appropriately with appropriate furnishings and sufficient lighting. Bedroom #1 had one bed without linens or blankets. The other linens are clean and in good condition. Extra linens are found stored in the linen closet located between bedrooms #1 and #2. Continues on LIC 9099C... BATHROOMS: Bathroom was clean, shower area was in clean condition with grab bars, and a non-skid mat available. Hand washing sign was displayed, and sufficient amounts of soap and paper products in the bathroom. OUTDOOR AREA: Backyard has a covered outdoor area equipped with outdoor furniture for residents’ use. There were no bodies of water noted. The side gate is unlocked. The gate has an alarm system. Several items(empty food plastic canisters, plastic bags, monitor, non-operational refrigerator, and metal long pieces were observed, which need to be removed from the seating outdoor/backyard area. RECORDS: Records review began at 11:00 a.m., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Five out of six residents' physicians reports(LIC 602) TB Test section 6. was incomplete and did not have date test give, read, type of TB test. Six out of six Personal Property and Valuables form(LIC 621) first page was not filled out. Five out of six residents' records were missing residents' or/residents' representative signatures on different required forms: Admission Agreements, Personal Rights, etc. Two out of six residents files did not have physician's orders for hospice/home health care. The LPA reviewed the following documents: - LIC9020 Client Roster - Liability Insurance Due to time constraints, the LPA will conduct a continuation inspection at a later date. Facility staff representative signed today's report. A copy of the report was issued.