Pre-licensing visit·May 4, 2023

At 10:00am, Licensing Program Analysts (LPA) Angela Panushkina conducted a Pre-License visit to this facility and met with Administrator, Maro Podrumyan. This is a Change of Ownership Application from facility license number # 197610308 to # 197610411 . LPA conducted an entrance interview with the Administrator. At the time of this visit LPA observed and assessed three (3) residents present in the facility. All residents appeared to be clean and groomed. A Fire Clearance dated 03/01/2023 was received for six (6) residents, of which five (5) could be non-ambulatory residents, and one (1) bedridden in room #5. Facility has a hospice waiver for four (4) residents. The purpose of today’s visit is to inspect the facility to ensure compliance, under California Code of Regulations, Title 22, Division 6. An emergency exit plan/sketch is posted by the entrance. The facility has a total of five (5) bedrooms, three (3) of which are private and one (1) shared room. Resident bedrooms were observed to be appropriately furnished. There are two (2) bathrooms in the facility designated for resident use and were observed to have non-skid mats and appropriate grab bars installed. At 10:15am, the hot water was tested and measured at 109.3°F. The facility will have awake staff at night and bedroom #1 is designated for staff use only. The facility appeared to be clean, in good repair and kept at a comfortable temperature of 74°F. The common areas (living room, kitchen and dining areas) were appropriately furnished, and lighting was adequate. At 10:20am, LPA observed all kitchen knives in the kitchen drawer kept locked and inaccessible to residents in care. Appliances in the kitchen appeared to be functional. LPA observed sufficient supply of two days perishable foods and one week of non-perishable foods on premises. A fire extinguisher located in the kitchen was last serviced on 10/24/2022. At 10:30am, LPA observed resident and staff records with all medications were centrally stored in a locked closet located in a hallway. The first aid kit is readily available. Dual carbon monoxide and a smoke detector were located throughout the facility, and at 10:35am they were tested and observed to be operational. There is a functioning telephone on the premises. Continue on LIC809-C The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors and locked areas for centrally stored medications. Plan of operation for dementia residents was also discussed with the Administrator. The attached garage is kept locked. The attached garage is currently being used for perishable and non-perishable food storage. The laundry area is located by the attached garage and at 10:50am LPA observed all detergents, cleaning supplies and other toxins are kept locked and inaccessible to residents in care. At approximately 11:00am LPA toured the outside area of the facility. The facility has a swimming pool that is fenced all around with a gate and will be kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around its parameters. LPA also observed a clean covered patio and backyard furniture to accommodate the six (6) residents . LPA discussed the importance of maintaining care and supervision to meet the needs of residents. Between 11:00am to 11:30am, LPA reviewed records of one (1) resident and one (1) staff. Resident and staff records appeared to be complete and updated. Component III was conducted with the Administrator. The facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved. The exit interview was conducted with the Administrator and a copy of this report was signed and delivered.