Non-compliance follow-up·February 15, 2024

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced case management - legal/non-compliance visit. At 9:28 a.m., the LPA met with staff and explained the reason for the visit. At 9:40 a.m., the Administrator Kajo Movsesian arrived at the facility. The purpose of today’s visit was to monitor the licensee’s compliance with Title 22 Regulations. The facility is on a two-year Compliance Plan. The LPA focused today’s visit on resident records and personnel records. RECORD REVIEWS: Between 9:50 a.m. and 11:26 a.m., the LPA conducted a file review for all six (6) residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to, care plans, medical records, admissions agreement, consent forms. It was noted that a disaster drill was conducted on 01/08/2024 and fire drill was conducted on 01/12/2024. All files were in order. The Administrator’s certificate expired on 12/19/2023 and is in the process of renewing. At 12:00 p.m., the LPA along with the Administrator, conducted a brief physical plant tour. At 12:01 p.m., the LPA observed two (2) fire extinguishers to be last serviced on 11/03/2022. During the time of the visit, the Administrator had the two (2) fire extinguishers serviced. The hot water temperature was measured in all bathrooms and was found in compliance between 105.3 and 106.8-degrees Fahrenheit. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiency was cited (refer to LIC 809-D) Exit interview conducted. A copy of the report and appeal rights were provided.