Routine inspection·July 15, 2025

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced visit at this facility for a One (1) year Required visit. LPA met with staff Maria Rivera who called the Licensee Andranik Khunkayan and explained the purpose of the visit. The administrator is doing an assessment at this time. License's wife around twenty (20) minutes later. A tour of the physical plant was conducted at 12:36 PM. The facility has a total of five (5) bedrooms and two (2) bathrooms. One of the room is designated for staff use only. The facility is a one (1) storey building on the hill with the garage underneath. There is also a lift located just outside the garage for non-ambulatory and wheelchair bound resident. The facility fire cleared for six (6) non-ambulatory residents, one of which may be bedridden in Room #3. Hospice waiver for six (6) residents. There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation plan and Infection plan. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 75°F. The carbon monoxide and smoke detector are tested and observed to be operational. Smoke detectors are hardwired and interconnected. Fire extinguisher was observed to be full and last bought on 06/03/25. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water at the facility. (continued on LIC 809-C) (continued from 809-C) There is a two (2) car port located at the front of the facility. There is a garage below the house which is currently being used as a laundry and storage area. The garage was locked during visit. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, pesticides and other toxins are stored in the garage and observed to be locked and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene products on each bathroom which is provided by the licensee. Staff Rooms: Staff rooms are locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 110.3°F to 117.2°F. There is sufficient supply of clean linen available in stock at the cabinet. Medications : LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Complete first aid kit is readily available. Client records : Client records are reviewed. All clients record reviewed appeared to be complete and updated. Staff records : LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated. Disaster drill was last conducted on 05/28/25 . Required posting observed in facility (complaint hot line poster). Exit interview conducted and copy of this report issued.