Routine inspection·May 5, 2022

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced annual visit at the facility with focus on the infection control domain, food, and medication review. LPA Flores met with Lourdes Sandoval caregiver and explained the reason for the visit. Administrator Nvard Gevorkian arrived 30 minutes later. Facility is licensed to served 6 bedridden residents over the age of 60 and serves residents with dementia. Facility has a hospice waiver for 6. The indoor facility has 6 bedrooms, 2 bathrooms, a living room, a dining room, a kitchen and a detached garage. The outdoor facility has a front yard, and back yard. Facility has a sound auditory device in entry and exit doors. No large bodies of water were observed. Smog/Carbon monoxide detectors were observed, tested, and are in working condition. Fire Extinguisher was observed outside bedroom #1 and current. LPA Flores toured the facility with Lourdes Sandoval Caregiver and observed the following: Living/dining room has sufficient sitting area, activities were observed for residents in care. Kitchen was observed to maintain sufficient food for at least 2 days of perishables and 7 days of non-perishables. Sharps, cleaning supplies, and medication were observed locked. All bedrooms have sufficient lighting, furniture, and bedding. Bathroom #1 is used for visitors and staff, residents do not use the shower, water temperature was tested at 111.6 degrees F. Bathroom #2 was observed to have grab bars and skid mat in the shower, cabinets with hygiene products and cleaning supplies were locked, and water temperature was tested at 109.8 degrees F. LPA Flores reviewed 5 residents medication and files and 3 staff files. Staff #2 is missing TB test. Administrator Certificate observed #6050643740 exp:12/23/22 Facility is following COVID recommendations regarding cleaning, screening, social distancing, and monitoring. N95 Fit testing for staff must be conducted and TB test for staff #2. Deficiency has been noted on LIC 809D per Title 22 Regulations Chapter 6 Division 8. Exit interview was conducted with Nvard Gevorkian administrator and a copy of this report, LIC809D, technical advisory, and appeal rights were provided.