Routine inspection·October 7, 2025

On 10/07/25, at 10:15am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct an unannounced annual visit of the facility. LPA met with Facility Administrator, Ruzanna Sukiassyan, and reason for the visit was disclosed. Facility is licensed as a single-story residence; fire clearance is licensed for six (6) non-ambulatory residents; ages 60 and older. Two (2) residents may be bedridden; hospice waiver is for four (4) residents. Facility has four (4) bedrooms, and two (2) bathrooms. Currently, there are (1) residents receiving hospice services. At 10:40am, LPA conducted a tour of the physical plant with the Ad ministrator, and observed the following: Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access point. Emergency exits are at the rear of the living room area . Visitor Sign-in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, and other related signage is posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 74.0°F; within the required range . Required postings are prominently displayed and observed to be current. Disaster drills were last conducted on 6/15/2025. Fire detection: Sensors (Dual smoke carbon monoxide detectors) are located throughout the facility. Detectors were tested and function properly. LPA observed one fire extinguisher hanging on the wall in the kitchen area; last service date was 9/20/25. [LIC 809C]-Continued KITCHEN: LPA observed kitchen as clean, equipped with a functional stove, multiple appliances, and stocked with an adequate supply of perishable and non-perishable foods. Emergency food is stored and locked in pantry cabinets near the kitchen area. Food is observed as properly labeled and stored. Kitchen cabinets contain dishes, plastic, paper goods and utensils. Knives and sharps are stored and locked in kitchen drawer, inaccessible to residents. MEDICATIONS: Medication room is located in a living room storage closet; area was found locked and inaccessible to residents. Facility has fully stocked first aid kit and manual located and in the medication area. However, centrally stored prescription and PRN medication has NOT been logged showing medication dispensing charting. Deficiency will be cited on LIC 809-D. LAUNDRY: LPA observed the laundry room located in storage room across from the kitchen area. Laundry machines, soaps, and other cleaning agents are secured and inaccessible for residents. Linen storage was observed to have adequate supply of linen and towels. GARAGE: There is no garage at the facility; only a driveway in the front of the facility. COMMONS: LPA observed all common areas of the facility, including the resident dining area. LPA observed common areas to be clean, organized, properly furnished and in excellent condition. Facility is furnished with piano, television, reading materials, and board games for residents use. BEDROOMS: All bedrooms are observed as clean and clear of clutter, with sufficient lighting, properly furnished with bedding, linens, and at least one chair, and night stand. BATHROOMS: All bathrooms were observed to be clean and sanitary with necessary supplies, and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 108.0°F. Within the required range. OUTDOOR: The (backyard) area observed to have a shaded patio, with table, and sufficient seating for the residents. Outdoor furniture was observed to be in good condition. A storage shed in the backyard contains PPE and incontinent products for residents; shed was observed as locked during the visit. Outdoor area observed as clean and clear from obstruction. No bodies of water are located on the premises. [LIC809C]-Continued RESIDENT RECORDS: Records were located in the living room storage closet; locked and inaccessible to residents. A total of three (3) resident files were reviewed for current IPP and/or Needs and Services plans, physician report, admission agreements and all relevant documents. Resident records appeared to be complete and current. STAFF RECORDS: Records were located in the living room storage closet; locked and inaccessible to residents. A total of four (4) Staff files were reviewed. Criminal record clearances were present, and Staff are associated to this facility. Staff records appear to be complete and current. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.