Routine inspection·October 18, 2025

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual inspection. LPA was greeted by staff and informed them of the reason for the visit. Administrator Laila Kulungu was called and reason for the visit was explained. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN : Kitchen knives are stored locked and inaccessible in a drawer in the kitchen. The facility has a sufficient supply of perishable and non-perishable food. Appliances in the kitchen were clean and functional. There is an adequate supply of emergency food and water. Medications are stored in a locked kitchen cabinet and files are stored in a locked filing cabinet in the office area next to the kitchen. GARAGE/ LAUNDRY : The attached garage by the kitchen is kept locked. LPA observed the pantry, an additional refrigerator/freezer, and a washer and dryer. Laundry detergent and chemicals are stored inaccessible in the garage. BEDROOMS : There are six (6) bedrooms in the facility; all bedrooms for resident use are private. There is no staff room in the facility as there is no live in staff. Three (3) of six (6) rooms have direct access to the outside. Lighting in the rooms is adequate. All resident rooms were set up with beds, night stands, lighting, chests of drawers, chairs and closet space. Full rail observed on resident #1's (R1) bed. R1 is not on hospice. BATHROOMS : There are three (3) full bathrooms. There are two (2) private bathrooms for resident use and one (1) hallway bathroom for resident use. The showers are equipped with nonskid surfaces and nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature in bathrooms measured between 106.9 – 111.7 degrees Fahrenheit, which is within the required range. COMMON AREAS: Common areas were appropriately furnished and in good condition. The facility smoke alarm system is hard wired; smoke detectors were tested and were operable at the time of the visit. (Continue to LIC809c) Fire extinguisher located in the kitchen was observed fully charge with receipt dated 10/16/2024. Administrator stated she will have a new fire extinguisher at the facility by Monday, 10/20/2025. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted in the main hallway area wall. Other required postings are also posted on the main hallway area wall. EXTERIOR : The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located directly outside the sliding doors from the living room. There is a gated and locked pool in the backyard. The facility has a self-latching exit gate located on both side passageways. The garage is attached to the property and is used for additional storage, emergency supplies, additional food and laundry. RECORD REVIEW: Records review began at 12PM-1:30PM. LPA observed all four (4) resident records for documents including, but not limited to: needs and service appraisals, medical records, admissions agreement, and consent forms. LPA observed three (3) personnel records for documents including, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Personnel files reviewed were in order and had no missing documents. At 12:30PM, LPA observed three (3) out of four (4) resident files to be missing a PRN Authorization letter from the physician for resident #2, #3 and resident #4. MEDICATIONS : Medications are stored inaccessible in locked cabinets in the kitchen and office area. Beginning at 2PM, LPA observed medications for two (2) residents. Medications were observed to be properly documented on the centrally stored medications and destruction record and were in compliance with regulation, state, and federal law. INFECTION CONTROL: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are not conducted quarterly as is required. Staff conducted a fire drill during the visit. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.