Routine inspection·July 30, 2024

Another LIC809 has been generated to reflect signatures that did not register or reflect on this report. Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced required 1-yr inspection. LPA was allowed entry by Maria Durand, caregiver at 11:30am and explained the purpose of the visit. At 12:00pm, Gevorg Khaluyan, Administrator/Licensee arrived, LPA explained the purpose of the visit. LPA reviewed resident files, staff files and conducted a tour of the facility between 12:00pm to 3:00pm. Outside : LPA toured the outside area. LPA observed a shaded sitting area for residents. There is a ramp access with sturdy hand railings. The facility does not have any bodies of water. Common Area : LPA observed all furniture to be clean and in good repair. The facility maintains a comfortable temperature at 73 degrees Fahrenheit. The air conditioner is operational. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Sprinkler systems are hardwired and interconnected. At 1:00pm they were tested and deemed operational. Facility maintains a telephone land line and it was observed to be operational. Required postings were observed. The fire extinguishers is located in the kitchen with purchase date of 04/26/2024. Food Service and Kitchen Area: The kitchen appliances were functional. The kitchen has a working stove, faucet, refrigerator and microwave. LPA found enough food for at least three (3) days perishable and seven (7) days non-perishable which are properly stored. Knives were stored in a magnetic lock drawer. Food preparation areas are clean. Garbage can have a tight fitting cover. The laundry room which is inaccessible and locked is located near the kitchen area. There is a functioning washer and dryer. Laundry detergents and cleaning solutions were stored in the locked laundry room. Residents' dining table accommodates six (6) people. Continued to LIC809-C Bedrooms: LPA observed all four (04) bedrooms to be properly furnished with appropriate dresser, night stand, chair, beddings and linens with sufficient lighting. Extra linens and beddings are stored in the hallway closet. Bedroom #1 is occupied currently by one (1) resident. Bedroom #2 is for staff use only, which remained locked. Bedroom #3 is occupied and shared by two (2) residents. Bedroom #4 is not currently occupied. Bedroom #5 is occupied by one (1) resident. Bathrooms: LPA observed two (02) bathrooms at the facility, one (01) is for residents to use and one (01) is for staff use only which is kept locked. Resident bathrooms have hand washing signs, soap and paper towels. Proper grab bars and non-slip bath mats. The water temperature in the resident bathroom is 112.7 degrees Fahrenheit. Personnel Records/Staffing: LPA Reviewed files for four (4) staff members. Files are maintained at the facility in a locked 4 drawer cabinet. Proof of staff training, health clearance, vaccinations and 1st Aid/CPR training are current for two (2) staff members. Staff employed all have criminal background clearance, fingerprint cleared and associated to the facility. LPA observed two (2) caregivers S1 and S2, 1st Aid/CPR certification were expired. Residents Records: LPA reviewed files for four (04) out of four (04) residents. Files are maintained at the facility in a locked 4 drawer cabinet. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, and Admission agreements, Medical/Functional assessments, Needs and Services Plans, Personal rights. Medications were reviewed for one (01) resident to confirm medication is given as prescribed and is documented properly. The facility uses the Medication Administration Record (MAR) log to document medications given. Medications are administered as prescribed by the Physician. Medications are bubbled packed. Medications are in a locked cabinet The First Aid Kit is complete and current. Deficiency issued. An exit interview was conducted, and a copy of this report was provided to licensee/administrator. .