Routine inspection·May 1, 2025

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Liza Mesdjian was notified via telephone and was unable to attend the visit in person but was presented with the present report over the phone before agreeing to have a staff member sign on her behalf. There are currently six residents in care, two of which are receiving hospice care at this time. LPA observed residents relaxing in the facility's common living areas or in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with an attached garage. The facility has six private rooms along with one staff room. There are two shared bathrooms as well as multiple en-suite half bathrooms throughout the facility. Bedrooms appear clean and sanitary. Two residents are currently using half-rails for postural support. A third resident sleeps in a bed equipped with full rails. Appropriate physician orders and/or hospice plans of care on file for all three residents. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary. Hot water temperature measured at 119F in one bathroom and one half-bathroom with faucets used for personal grooming. A third measurement in the second shared bathroom was found to be 138F. Water heater adjusted during the visit. Type B citation issued. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning products and the medication central storage all verified to be secured. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Fire extinguishers are charged and mounted, with up-to-date maintenance documented on the attached tags. LPA tested the smoke and carbon monoxide detectors which were found to be operational. The attached garage is inaccessible to residents and used for laundry as well as additional storage of food and supplies. LPA and facility staff toured the outside of the facility. LPA observed an shaded outdoor seating area with furniture for resident use. There are self-latching gates on both sides of the property and the routes of egress are free of clutter and obstructions. There are no bodies of water on the premises. Facility does not utilize locked perimeters or delayed egress. LPA reviewed six resident records which included all necessary components. LPA reviewed resident medication records and prescription orders for all residents with no discrepancies observed. One resident's assessment however indicates that he needs assistance with self-administration of medication. There is a physician note on his medication list stating that he may manage his own supplements and vitamins, however medication and ointments are also present in the room. Staff is provided with a Technical Violation Advisory Note informing them that the resident's assessment needs to be more precise in defining which substances are safe for the resident to handle. Information on the updated requirements for an annual medical assessment also provided. The RCFE Complaint poster PUB475 is also observed to be printed on an 8x10 sheet of paper rather than the required 20x26. Type B deficiency cited. Oxygen is not currently in use. There are no bedridden residents present on the premises. LPA reviewed staff records for two caregivers present. None of the two staff members has a current CPR/First aid certificate. Type B deficiency cited. Initial and annual training reviewed and up-to-date. All staff are background cleared and associated to the licensed location accurately. Disaster drills are conducted quarterly. Based on the observations made during today’s visit, three deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative along with appeal rights