Routine inspection·March 28, 2024

Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Liezl De La Cerra conducted an annual required visit and inspection of the facility. LPAs was met with Danil Stukov who is the staff and was explained for the reason of the visit. At 3:00 PM Anush Badalayan who is the Licensee met with LPA, explained the reason for the visit. At 3:24 PM, with the assistance of Licensee, 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 3/28/2024. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; 1 bedridden; hospice waiver for 6. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPAs 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 a locked in the drawer. 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 away in the cabinet under the sink and laundry room. Bedrooms: There were four (4) bedrooms designated for residents' use. Bedroom #1 and bedroom #2 are for private used. Bedroom #3 is shared; bedroom #4 is vacant. The bedrooms that are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #5 is for staff. Continue to LIC 809-C Bathrooms: There are two (2) bathroom designated for residents' and staff use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 116 degrees Fahrenheit for bathroom #1 located inside bedroom #2. Bathroom #1 needs to have the toilet cleaned and changed the non-skid mat. Deficiency will be cited on LIC 809-D. Bathroom #2 is across bedroom #4. Hot water temperature was measured at 117.2 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPAs 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). LPAs observed common areas to be very clean and tidy. Fire place is close, block-off, and non-operational. LPAs 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 not have a swimming pool or body of water. The garage detached and is used for storage. Laundry service: Laundry is beside the kitchen. There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the kitchen under the sink and laundry room. Staff Files : LPAs also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is beside the dining table. Records were checked for expired or missing certificates and clearances: LPAs 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, and HIV/AIDS and TB training. Facility has missing fingerprint clearance for one (1) out of four (4) staff review. Civil penalty will be issued. 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. Medication was not lock when LPA arrived. Deficiency will be cited on LIC 809- D. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed client’s files for current records only for some residents. Two (2) out of four (4) residents are missing physicians report, appraisals, functional capability, TB test, and diagnoses. Deficiencies will be issued on LIC 809-D. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. Deficiencies were found, this will on LIC 809-D, exit interview conducted, copy of report has been issued and discussed.