Routine inspection·April 27, 2023

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 11:04 AM. LPA was greeted and asked to sign in by facility staff. LPA then met with Licensee/Administrator Gulira Atakeeva. Entrance interview conducted. At 11:20AM, the LPA, along with the Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: The facility is a two-story residence, however the upstairs area is designated for staff use only and is made inaccessible using a gate. LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The downstairs area of the facility consists of 5 (five) total bedrooms, 4 (four) are designated as private resident rooms and 1 (one) is designated as a shared resident room. RESTROOMS : Downstairs area contains 4 (four) total restrooms, 2 (two) of which are private restrooms and 2 (two) are designated as shared restrooms. All restrooms observed were clean and sanitary and in operating condition with grab bars and non-skid surfaces. At 11:27AM, hot water measured at 124.7 degrees Fahrenheit in Room 1's private resident restroom and at 11:34AM, hot water measured at 125.2 degrees Fahrenheit in one of the shared resident restrooms. COMMON AREAS : The LPA observed common area to be relatively clean and properly furnished at the time of the visit. The LPA observed the fire extinguishers to be fully charged and last serviced on 02/15/2023. A fireplace was observed to be adequately screened and inaccessible to residents in care. At 04:40PM, fire alarms and carbon monoxide detectors were tested and functioned properly. The temperature was maintained at a comfortable level. Report Continued on LIC 809-C KITCHEN: At 11:40AM, LPA observed the kitchen/dining area. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives are stored in a locked drawer in the kitchen. Chemicals and cleaning supplies are stored locked under the sink. Access to the locked garage is through the kitchen. Garage was observed to be locked and contained additional food supply storage, as well as separate chemical storage and the laundry area. OUTDOOR SPACE: At 11:47AM, the LPA observed the backyard, which has a covered outdoor area for resident use. There are no bodies of water noted. Gates on both sides of the facility are self-closing and self-latching. RECORD REVIEW: Began at 11:55AM, staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 5 (five) resident records reviewed were complete and contained all required documents. 1 (one) staff (Staff #1 - S1) of 5 (five) staff files reviewed did not contain a fingerprint background clearance. 2 (two) of 5 (five) staff files reviewed did not contain a health screening (S1 and Staff #2 - S2.) 3 (three) of 5 (five) staff files reviewed did not contain sufficient training documentation (S1, S2, and Staff #3 - S3.) MEDICATION REVIEW: Began at 12:58PM. Medications for 5 (five) residents were observed. Prescription medications reviewed were documented and labeled in accordance with regulation. However, over the counter medications for Resident #1 (R1) and Resident #2 (R2) were not labeled per regulation. Additionally, R2 had prescription orders for calcium carbonate, but is using Calcium +D3 gummies instead and prescription for Rezyst Probiotic 250mg but is taking Culturelle probiotic gummies. INFECTION CONTROL: During today’s visit, the LPA spoke with the Licensee regarding the facility’s infection control practices. The facility’s policies and procedures as it pertains to infection control are adequate. INTERVIEWS: Beginning at 03:09PM, LPA interviewed 2 (two) staff and 2 (two) residents. The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. A civil penalty was issued in the amount of $300. Exit interview conducted. A copy of the report was provided.