Routine inspection·April 30, 2025

Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA was met with Tyler Grant who is the staff and was explained for the reason of the visit. At 12:35 PM Anush Badalayan who is the Licensee met with LPA, explained the reason for the visit. At 12:49 PM, with the assistance of Licensee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 2:17PM smoke alarms were tested and were 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 3/26/2025. During the visit the facility is at 71 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. 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 a locked cabinet. 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 five (5) bedrooms designated for residents' use. Bedroom #1 and bedroom #2 are for private used. Bedroom #2 is vacant. Bedroom #3 and bedroom #4 is shared.. The bedrooms that are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Bedroom #5 is for staff is locked and inaccessible to residents. 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 117.8 degrees Fahrenheit for bathroom #1 located inside bedroom #2. Bathroom #2 is across bedroom #4. Hot water temperature was measured at 118.9 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway. 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. Fire place is close, block-off, and non-operational. 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 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 : LPA 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: 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, 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 CSMDR. 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, residents #2 (R2) and residents #4 (R4), are missing physicians report. Deficiencies will be cited in LIC 809-D. Planned activities are offered. Deficiencies were cited in LIC 809-D, facility is not within CA code of Regulations Title 22 or Health and Safety Code Exit interview conducted, copy of report has been issued and discussed.