Routine inspection·March 4, 2022

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced Required One (1) year - Inspection to this facility. Upon arrival, LPA met with Staff Armine Oganesyan. Administrator Yelena Amirjanyan arrived shortly after, and assisted with the visit. The purpose of the visit was explained. The facility is licensed to serve 6 (six) ambulatory residents ages 60 and over of which 1 (one) may be bedridden. Facility is approved to retain 2 (two) residents on hospice. The facility cares for elderly residents with dementia. LPA Nune Margaryan inspected the physical plant including but not limited to the kitchen, dining and living room, bedrooms, bathrooms , laundry area, and outside areas of the facility to ensure compliance with Title 22 regulations. LPA also conducted the infection control domain tool. There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit. LPA inspected the interior and the exterior of the facility with the Administrator including but not limited to: living /dinning room, office / storage room, kitchen, three (3) resident bedrooms, three (3) bathrooms, laundry located outside, backyard and garage. All indoor and outdoor passageways are free of obstruction. Bathrooms and bedrooms were clean and in good repair. There is a locked storages for medications in the kitchen. The common areas including the living / dining room are clean and have the required furniture. The backyard has a shaded area and sitting area. In the back yard right next to shaded / sitting area LPA observed cabinet which contains cleaning supplies / chemicals. It was not locked or inaccessible to residents. The facility has camera in the leaving / dining area only. Continue 809C All residents bedrooms were toured. Each bedroom has a smoke detector, bed, linen, dresser, light, and sufficient closet space. Both bathrooms were toured. Bathrooms have the required grabs bars and non-skid mats. The hot water was 117.5 and 118.2 degrees which is within the required 105 - 120 degrees. LPA observed fire extinguisher near the kitchen which was fully charged. Smoke detectors were observed throughout the facility. First-aid Kit is complete and located in the kitchen. LPA reviewed residents files to confirm emergency contact is updated. LPA also reviewed staff files to confirm health screenings and fingerprint clearances. All staff files reviewed were fingerprint cleared. Residents' medications were reviewed. Medications are documented properly and stored appropriately. The deficiency cited is documented on the attached 809D. A copy of the report and appeal rights will be provided to Administrator.