Routine inspection·July 19, 2024

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:22 AM. LPA was greeted by Facility staff who contacted the facility house manager Maro Podrumyan as administrator Susanna Gasparyan was unavailable for today’s visit. House manager arrived to the facility at approximately 09:45 AM. Entrance interview conducted. Beginning at 09:46 AM, the LPA, along with Facility house manager toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN : The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (2) days perishable and two (7) days non-perishable food and emergency water. The LPA observed one designated cabinet where knives and sharps are stored locked and inaccessible to residents. All food inspected was of good quality and not expired. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. Facility has one exit gate that was observed at 09:54 AM to fail to self-latch, LPA observed clear passageways for emergency exit use. There is a fenced off pool that was observed to be locked and inaccessible to residents in care at the time of the visit. LAUNDRY & GARAGE : The laundry room is located in the garage adjacent to the kitchen. The entry to the garage was observed to be locked and inaccessible to residents. Laundry supplies and chemicals are stored in a cabinet. Garage contained adequate emergency food and water supplies. Report Continued on LIC 809-C Continued from LIC 809 COMMON AREAS : This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. Cameras were observed in the common areas audio is not recorded. A properly screened fireplace was noted in the living room / dining room. The LPA observed the fire extinguisher to be fully charged and purchased on 05/29/2024. Smoke detectors and carbon monoxide detectors were tested at 10:33 AM and were functional at the time of the visit. BEDROOMS : There are four (4) bedrooms in the facility; all are designated for resident use, including two (2) shared rooms, All 4 (four) resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. BATHROOMS : There are two (2) bathrooms for resident use, one (1) of which is a shared resident restroom located in the hallway and one (1) is a private resident restroom. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms a grab bar in the private resident restroom was observed to be loose at the time of the visit. The water temperature was measured at 118.8 degrees Fahrenheit, which is in compliance with regulation. RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. Resident files for two (2) residents lacked TB tests. Additionally, 5 (five) out of 6 (six) resident files lacked appropriate emergency contact information for resident’s physicians and dentists. Employee file reviews showed that 1 (one) employee lacked up to date trainings and 1 (one) employee lacked appropriate medication training. MEDICATION REVIEW: Medications for 2 (two) of five (5) residents were observed. All medications reviewed were documented and no deficiencies were observed during medication review. Report Continued on LIC 809-C Continued from LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Last emergency disaster drill was conducted 06/12/2024. INTERVIEWS: LPA interviewed two (2) staff and one (2) residents. 2 (two) out of 2 (two) residents stated that they wished there were more activities for them to participate in at the facility. Both staff were knowledgeable on their roles and responsibilities. During today's visit LPA obtained a copy of the facility's LIC 500 and liability insurance. The following deficiencies were observed (See LIC 809-Ds) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Licensee was advised that failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.