Facility is licensed to serve five (5) non-ambulatory residents, one (1) may be bedridden in any room. The facility also has an approved hospice waiver for six (6) residents. The facility currently has 5 non-ambulatory residents. Three (3) residents are receiving Hospice services and 1 resident is receiving Home Health Services. Facility completed its last fire drill on 09/27/2023. The Annual Licensing Fees are current.

The home consists of 1 floor level with: 1 staff room, 4 resident rooms, 3 restrooms, kitchen, dining room, and laundry room.

At 10:00 AM with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. LPA started facility plant tour. The administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises.

Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 117.5-118F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. The facility has three restrooms.

Common areas were clean and clear of hazards, doorways were free of obstructions. The living room was properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit.

Laundry Room is in the backyard both washer and dryer are in good working order. All chemicals and cleaners are stored in locked cabinet next to the appliance.

LPA toured the kitchen area and observed a two day supply of perishable and a seven day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. The kitchen temp was measured at 118F. LPA observed hand washing signage. First Aid kit was available and stored in the medication cabinet in the middle hallway. One fire extinguisher last serviced 11/20/2023 was observed in the kitchen area. LPA tested all carbon monoxide detectors and smoke detector located in the kitchen area. Both devices were functional. LPA observed that all bedrooms and hallways are equipped with a carbon monoxide and smoke detector.

At 11:00 AM LPA Alemoh reviewed five (5) staff records were reviewed, 5 out of 5 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions.

At 12:05 LPA Alemoh reviewed five (5) resident records were reviewed and, 5 out of 5 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans.

At 01:00 LPA Alemoh reviewed Medication and Medication Records contained proper documentation for Five (5) of Five (5) residents.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were cited (refer to LIC 809-D) or no deficiencies observed during the visit.

Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued to Administrator Arsen Grigoyan.

.