Routine inspection·July 23, 2021

Licensing Program Analyst(s) (LPAs) Alma Gonzalez and Luis Mora conducted an unannounced annual visit at the facility. LPAs met with Willeta Frani, caregiver and explained the reason for the visit. LPA spoke to Administrator, Emma Topadzuikyan who stated that she would not be able to assist LPAs with the visit but that Caregiver Frani would be able to assist LPAs. The facility is licensed to serve 5 non-ambulatory residents ages between 60 and over and a hospice waiver for 2 hospice residents. Facility is a one story single home that consists of the following: 3 bedrooms, 4 bathrooms, garage, gated pool with pool house. Backyard has an area with tables/ umbrellas for shade. Facility has a living/dining room, kitchen. Pool house is inaccessible to resident's and residents favor sitting out in the front shaded porch versus sitting in the backyard. LPAs conducted a tour of the facility along with Caregiver Frani and observed the following: Facility's Kitchen has sufficient food supplies for 2 days of perishables, and 7 days of non-perishables; LPA observed fresh fruit, frozen meats, vegetables, can foods and additional emergency food supplies and water. Sharps/knives were kept unlocked in the stove oven. Caregiver was asked to remove the sharps and place them in a locked a cabinet. Cleaning supplies were locked under the sink. LPA observed and reviewed first aid kit located in a kitchen cabinet and had all the required items. File cabinet with clients medication is located in the facility living room. At the time of the tour the file cabinet containing resident's medication was not locked. Bedrooms #1, #2, #3 have proper lighting, and furniture; beds have all the required bedding. Resident's bathrooms were observed to have skid mats, handle grab bars, client's hygiene products kept in cabinet, and water temperature was tested at 138.9 degrees F. LPAs observed linen and towels. Smoke detectors and carbon monoxide detector(s) were observed and tested. Fire extinguisher was observed in kitchen and had not been serviced and did not have a tag indicating when it was last serviced. There is sufficient lighting throughout the facility. The grounds are well groomed and there were no hazards observed. The front exterior of the facility is clear of debris with steps leading to the facility entrance. Trash containers have covered lids. There are no security bars nor weapons on the premises. LPAs observed that required documents are posted as mandated. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged and temperature checked, sanitizer/soap in the staff bathroom and additional sanitation supplies are locked in the garage. LPA observed hand sanitizer stations throughout the facility. LPA observed facility staff wearing masks, and required postings throughout the facility. The residents temperature's are checked and logged twice a day in the AM and PM. Facility has an adequate amount of PPE and facility has enough PPE for 30 days. As LPA's were completing annual visit, a live cockroach was observed crawling n the facility kitchen window which is located near were the kitchen table is located. Based on Title 22, Chapter 8 Division 6 deficiencies will be noted on LIC809D. Exit interview was conducted with Willeta Frani and a copy of this report, LIC 809D, LIC 9102, and appeal rights were provided.