Routine inspection·May 27, 2025

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:10AM. The LPA was greeted by staff, informed them of the reason for the visit, and staff notified the Administrator. Administrator Kajo Movsesian arrived at 9:19AM. Entrance interview conducted. Beginning at 9:21AM, the LPA and 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: 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 throughout the visit. LPA Huynh noted required signage and postings in the facility’s entryway. Smoke and carbon monoxide detectors were tested at 11:00AM and were operational at the time of the visit. One fire extinguisher was observed throughout the facility and was last serviced on 05/06/2025. LPA observed nightlights throughout the facility’s hallways. Additionally, a laundry closet is located in the hallway and was observed to be operable and in good condition. Report Continued on LIC 809-C BEDROOMS/RESTROOMS: There are four (4) total bedrooms: two (2) private and two (2) shared. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens are stored in the kitchen cabinets. There were two (2) total restrooms in the facility: one (1) shared restroom located in the hallway and one (1) private resident restroom. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 112.6 degrees F and 113.9 degrees F. OUTDOOR AREA: The backyard has an area equipped with furniture for resident and visitor use. There is one self-latching side gate for emergency use. No bodies of water noted, and exits are free of obstructions. LPA observed an Additional Dwelling Unit (ADU) fenced off in the backyard with residents who are unrelated to the facility. KITCHEN: The LPA observed the facility kitchen at 9:45AM. Knives are stored inaccessible in a locked cabinet. Cleaning supplies and laundry products were stored inaccessible and locked under the sink. Kitchen appliances were clean and in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency food and water. Food in the refrigerator was observed to be of good quality. The Administrator stated the facility does a grocery run once a week. RECORDS: Record review began at 9:55AM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 04/29/2025. MEDICATIONS: Medication review began at 11:04AM. Medications are centrally stored and kept inaccessible in the kitchen. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. One (1) staff and three (3) residents were interviewed. No complaints were reported. No deficiency cited. Exit interview conducted. A copy of today's report was reviewed and provided.