Routine inspection·January 7, 2025

This is an amendment report that civil penalty is updated to $1000 only. Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Nadia Shahbazian conducted an annual required visit and inspection of the facility. At 11 am staff Senya Issachenko and Darya Issachenko met with LPA, explained the reason for the visit. Staff was not associated with Guardian, a civil penalty will be issued. At 1:30PM licensee Anna Hakobyan arrived and was advised the reason of the visit. At 1:07 PM, with the assistance of staff, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen the charge date is 6.22.2024 During the visit the facility is at 75 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents. Hospice waiver for six (6). Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in an locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked in the kitchen below the sink. Bedrooms: There were three (3) bedrooms designated for residents' use. Bedroom #1, bedroom #2, and bedroom #3 are shared. Bedrooms that are used by the residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are two (2) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 118.8 degrees Fahrenheit in the bathrooms. Bathroom #1 is located beside bedroom #1. Bathroom #2 is inside bedroom #3. There was enough clean linen available in the cabinets in the laundry room. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control : Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds : Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does have a swimming pool it is fence up and lock. The garage is detached and is converted into an office. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area in the kitchen. Staff Files : LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. R2 injection was found in the refrigerator which was unlock and inaccessible. Deficiency will be cited in LIC 809-D. LPA also observed a surplus of medication for R5 and it was advised that they refuse to take medication. No incident report was receive. Deficiency will be cited in LIC 809-D. Resident records were reviewed for requirements and legibility: LPA reviewed client’s files for current appraisal. Planned activities are offered. Deficiencies were found and listed in LIC 809-D, exit interview conducted, copy of report has been issued and discussed.