Routine inspection·June 12, 2023

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 06/12/2023 at 1:300 Pm. LPA was met by Administrator Mnoyan and explained the pupose of the visit. Staff #9 (S9) assisted in tour of facility. Facility is licensed to serve residents over the age of 60 years old. The facility has a fire clearance for 130 non-ambulatory, 20 bedridden and is currently approved for 20 hospice residents. LPA requested and obtained a copy of Personnel Report, and Resident Roster. Observations: The facility is located on a residential street and is a single-story building. LPA toured physical plant and selected random residents rooms for inspection. LPA toured TV room, medication room, activities room, laundry room, theater room, and kitchen/dinning room area. LPA observed kitchen staff cleaning up kitchen after lunch service and observed several kitchen staff preparing dinner service. LPA observed kitchen to be clean and appliances appeared to be in working order. LPA observed sufficient 2 days of perishables and 7-day supply on non-perishables. Walk in freezer thermostat was observed to read 0 degrees F and walk in refrigerator thermostat was observed to read 40 degrees F. Dinning room area was observed to be clean and free from hazards. LPA observed dinning room tables to have seating charts. TV room, activities room, laundry room and theater room were all observed to be clean and free of hazards. LPA observed staff conducting a cooking class with residents in activities room. LPA selected rooms 116, 115, 120, 128, 136, 161 and 153 for inspection. Selected rooms a ll contained the required furnishings, linens and were observed to be clean with plenty of closet space. Water temperature in resident bathroom #153 was recorded as 109.7 degrees F. LPA observed and tested emergency call assist cord in resident bedroom # 120 . Emergency assist cord was pulled at 3:05 pm and staff responded at 3:07 pm. LPA observed fist aid kit located in medication. LPA observed several fully charged fire extinguishers throughout the facility. Due to time constraints, LPA will return at a later date to complete annual inspection. No deficiencies are being cited at this time. Exit interview was conducted with S9. A copy of this report will be emailed due to printer problems.