Routine inspection·April 30, 2024

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to caregiver Roberto Rios. Administrator Anna Khachatryan arrived shortly after. There are currently 5 elderly residents 60 years and older residing in the facility. The following 12 Care Compliance and Regulatory Enforcement (CARE) tool domains were utilized during the inspection. Infection Control: The facility has an Infection Control Plan & COVID Mitigation Plan. Supplies of Personal Protective Equipment (PPEs) were observed. Operational Requirements: An Infection Control Plan has been added to the Plan of Operation. The facility has a Dementia Waiver in place and an approved Hospice Waiver for 6 residents. A fire clearance for 6non-ambulatory residents; of which 1 may be bedridden in room $4 is in place. Liability Insurance in the amount of ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 5/30/2024. An American Red Cross 1st Aid kit and manual are readily available. No Surety bond is in place. Facility does not handle resident monies. *Narrative continues next page. Physical Plant/Environment Safety: The facility is a single-story home located in a residential area consisting of six (6) bedrooms, two (2) full bathrooms, kitchen, dining room, living room, laundry room, rear shaded patio area, and attached garage. The facility has two (2) fully charged fire extinguishers. Smoke and carbon monoxide detectors are operational. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances in the unlocked laundry room were observed accessible to residents. A citation was issued. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. No ne of the resident beds had mattress pads. A citation was issued. Residents (R3 & R5) have oxygen tanks in their rooms, but a a "No Smoking-Oxygen in Use" sign was not posted in appropriate area i.e., near the room door or at the facility entrance . A citation was issued. Staffing: A total of six (6) staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 3/8/2025. Four (4) staff files were reviewed. Proof of staff training, health clearance, food handling certificates, and 1st Aid/CPR training was observed. Staff have criminal background clearance and training. Resident Records/Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent, Individual Service Plans, and medication records. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted in the hallway. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. One (1) resident has a physician order f or modified diet. Incident Medical and Dental: Three (3) centrally stored resident medications were reviewed to verify there is a 30-day supply of medications. Resident (R1's) Irbesatan 300 mg & Alendronate Sodium 70 mg medications have not been refilled . A citation was issued. Medical and dental transportation is provided. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Records of resident Appraisal and Needs services plans are part of Emergency training. Residents with Special Health Needs: Three (3) residents are receiving hospice services. One (1) resident receives home health services. Postural support physician orders are on file. Full and half bed rails for mobility assistance were observed in some resident rooms. No residents have prohibited health conditions. Appraisals are on file. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Anna Khachatrya. A copy of the report and appeal rights will be emailed today due to printing difficulties.