Routine inspection·July 2, 2025

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:25AM. LPA met with staff upon arrival and Administrator Susanna Gasparyan who arrived at 10:51AM. Entrance interview conducted. At 10:32AM, the LPA along with staff and 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. KITCHEN: The LPA inspected the kitchen/food service area at 10:32AM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility had a sufficient supply of perishable and nonperishable food. At 10:34AM, LPA observed knives and sharps accessible to residents in care as the drawer lock failed to function. Staff were not knowledgeable in using the lock. Administrator was able to lock the drawer but stated that the lock will be replaced as it does not always function properly. At 10:40AM, LPA observed three (3) expired food cans dated between 05/01/25-05/25/2025, dry food products such as beans and rice stored in unlabeled containers, and an opened jam container that was opened and unrefrigerated but states to “refrigerate after opening.” At 03:30PM, Administrator installed a new and functional lock to the knife drawer during 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. LPA observed laundry supplies, cleaning chemicals and solutions, additional facility supplies, and emergency water supply in the garage. Report Continued on LIC 809-C BEDROOMS: There are four (4) resident bedrooms of which two (2) are shared and two (2) are private. Bedroom #3 has a direct exit to the exterior. LPA observed resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are two (2) restrooms designated for resident-use of which one (1) restroom is attached to resident bedroom and one (1) is located in the hallway . Restrooms were clean and sanitary and in operating condition with grab bars and slip-resistant surfaces. The restrooms were sufficiently stocked with supplies and paper towels. Hot water temperature was measured and were between 115.7-116.6 degrees Fahrenheit, which is within the required range. OUTDOOR AREA/GARAGE: The backyard has a covered outdoor area equipped with furniture for resident-use. There is a pool on the property that was observed to be gated and locked at the time of the visit. There is a self-latching gate on the side of the house designated for an emergency exit. At 10:58AM, LPA observed emergency exit passageway obstructed with a garden house and paver tiles. Administrator cleared obstructions immediately. COMMON AREAS: The common spaces included the living room and dining area. LPA observed camera in living room without an audio component. All areas were clean, sanitary and in good repair. The facility smoke alarm system is hard wired; the combination smoke and carbon monoxide detectors were tested at 11:08AM and were operable at the time of the visit. The fire extinguisher was observed be fully charged and last purchased 06/26/2025. Auditory exit alarms were tested and functional at the time of the visit. LPA observed required postings in the entrance hallway. MEDICATION REVIEW: Beginning at 11:10AM, LPA reviewed medications for two (2) of five (5) residents. Medications were centrally stored and locked inaccessible in cabinet by the kitchen. All medications reviewed were properly documented and no deficiencies were observed during medication review. RECORD REVIEW: Beginning at 11:30AM, LPA reviewed five (5) out of five (5) resident files and three (3) personnel files for documents including but not limited to: medical records, care plans, resident Admission Agreement, TB test, health screening, staff training, first aid certification, and fingerprint clearance. Four (4) out of five (5) resident files and all three (3) personnel files were in order. CONTINUED ON LIC809-C. LPA observed Resident #1 (R1)’s physician’s report dated 06/19/2024 documenting R1 with Diabetes type II and marked “NO” for “able to administer own injections” and “able to perform own glucose testing.” Per regulation, licensees are permitted to retain residents with diabetes only if the resident is able to perform their own glucose testing and self-administer their medication, or get it administered by an appropriately skilled professional. Administrator stated that R1’s physician’s report is not accurate as it was not completed by R1’s primary physician and that R1 self-administers their insulin. Administrator stated that facility staff perform R1’s glucose testing but R1 would be capable of self-testing. Administrator contacted R1’s primary physician during the visit and scheduled an appointment to get R1 re-evaluated with an updated physician’s report. LPA had a discussion with the Administrator regarding the facility’s responsibility of ensuring residents’ medical assessments and appraisals are current and accurate. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control policy and emergency disaster plan. Emergency disaster plan is updated annually as required and emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 05/01/2025. All documents reviewed were updated and in compliance. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22. Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.