Routine inspection·October 12, 2024

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Maricela Sosa and explained the reason for the visit. Facility is licensed to serve 6 non-ambulatory residents over the age of 60, of which (4) may be bedridden and (2) non-ambulatory, with a hospice waiver for (2). Facility is a single home located in a residential neighborhood an consist of (4) resident rooms, (1) bathroom, a kitchen, a living room, a dining room, a detached garage, a patio, a backyard and front yard. LPA Flores conducted a tour of the facility and observed the following: Facility is clean and in good repair indoor and outdoor. The living room has a fireplace which is covered with a metal stand. Facility has sufficient food supplies for at least (2) worth of perishables, and (7) days of non-perishables stored in the kitchen. Cleaning supplies, medication, and sharps were observed locked in kitchen cabinets. Laundry is located in the kitchen. Each resident bedroom has sufficient lighting, the required bedding and furniture. LPA observed bed rails in room #4(BR4) for resident #3(R3) and #4(R4). Bathroom was observed clean, with grab bars, skid mat, and in good repair. Water temperature was tested at 106.4 degrees F., which is within the required 105-120 degrees F. Facility has sound device in each exit door. Backyard has seating furniture under a cover patio. Fire extinguisher was observed and last checked on 10/9/24. All passageways are free of obstructions and debris. There are no large bodies of water in this facility. First aid kit was observed with all required items. Licensing posters were observed posted. LPA reviewed files and medication for (5) clients and (5) staff files. Administrator certificate was observed for Martin Adjian #6043740740 exp. date: 3/15/25. Staff #1(S1) was observed working at the facility. Per administrator staff began working on 10/10/24, fingerprint clearance was done on 10/7/24. (CONTINUED ON LIC 809C) Infection control plan and emergency disaster plans were reviewed and are in compliance. Deficiencies was noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Nvard Gevorkian and a copy of this report, LIC 809D, and appeal rights were provided.