Routine inspection·May 12, 2025

On 5/12/25 at approximately 12:00pm an unannounced annual visit was conducted by Licensing Program Analyst (LPA) Perchui Milena Khurshudyan. Upon arrival, LPA met with the Caregiver Rina Bayani, who granted access to the facility. LPA introduced herself by showing her badge and explained the reason for the visit. Shortly after the Administrator, Wood Cherie arrived and helped with staff/residents’ files and medications. During today's visit, LPA conducted a physical plant walk through, at approximately 12:55pm, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22.The following was observed: The facility is a single-story home and is licensed for capacity of six (6) residents, of which four (4) may be non-ambulatory and of which fire clearance for one (1) Bedridden. Facility also has a hospice waiver for four (4) residents. There are five (5) bedrooms of which four (4) are designated for residents’ use. All bedrooms observed to be appropriately furnished and have appropriate lighting. There are two (2) bathrooms in the facility designated for residents’ and staff use. LPA observed bathrooms have soap, paper towels and hand washing signs. The hot water temperature measured at 1:13pm to be 136°F. Extra towels and linens were readily available in the linen closet located in the hallway. There are grab bars for each toilet and shower, bathrooms have non-skid mats. All trash cans in bathrooms had fitted lids to protect from cross contamination. LPA observed facility alarms were present on all exit doors, however, the signals were off / Non-operational. SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 3:30pm they were tested and observed to be operational. The facility has one (1) fire extinguisher that was last purchased on 5/12/2025. Continue on LIC809-C KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA observed the kitchen area and found the refrigerator to be broken. LPA was informed by the Administrator that new refrigerator is purchased and will be replaced on 5/13/2025. There was sufficient stock of one-week non-perishable foods and two days of perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas observed to be cluttered and unorganized. LPA observed that sharp objects were stored inside the kitchen cabinet locked and inaccessible to residents in care. Extra emergency food was also properly stored inside the kitchen cabinets. Temperature was comfortable it was measured at 2:35pm to be 76°F. MEDICATION: LPA observed centrally stored medication is locked inside the commercial cabinets located in the dining/living room area. First Aid kit was locked inside the storage cabinet, inaccessible to residents in care and it was checked by the LPA to be complete with new manual attached to it. Facility has two (2) staff for AM shift and two (2) awake caregivers for PM shift. COMMON AREAS: LPA observed living room and a dining room that appeared generally clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Facility has land line; LPA checked its operational. LAUNDRY ROOM: Laundry machines are located by the kitchen area and observed to be operational. LPA observed chemicals/detergent stored openly in the backyard, available to residents residing in the facility. LPA discussed the importance of keeping potentially dangerous items locked at all times. SURROUNDING GROUNDS: LPA observed sufficient yard space with fenced backyard. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. Exit doors were unlocked however, obstructions were observed on the exit areas. The facility does not have a swimming pool or body of water. There is a garage in the property, which is currently being used for storage. FILE REVIEW : Between 2:00pm to 3:30pm, LPA reviewed records and files of six (6) residents and four (4) staff/caregivers. A review of staff and resident records appeared to be not complete. There are no residents with prohibited conditions residing at the facility. Continue on LIC809-C An emergency exit plan/sketch along with other posting requirements are posted on the wall by the entrance area. Medications Review : At approximately 12:35pm. LPA reviewed Centrally Stored Medication Destruction Records for proper documentation. Facility also maintains Medical Administration Records (MAR). PRN medications have written orders from a physician. Potentially dangerous items are kept inaccessible to residents in care. LPA collected LIC500, LIC9020, copy of Liability Insurance Certificate. Deficiencies issued during today’s visit. Exit interview conducted and copy of this report signed and delivered.