(See LIC809C for the continuation of this report)

• Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

• Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place but needs to be updated.

Physical Plant & Environment Safety: LPA conducted a tour of the physical plant areas inside and outside to ensure there are no health and safety hazards, and that facility follows Title 22 Regulations. The physical plant tour was conducted with the assistance of Zara Poghosyan, Director of Operations. The physical plant consists of a two-story building with 52 rooms with bathrooms in each room, offices, lobby, TV Room/ Activity Room, 2 dining rooms, kitchen, storage, laundry and outside patio. Resident rooms were randomly chosen for inspection and LPA observed that resident bedrooms have the required furniture, bed linens, sufficient lighting and closet/drawer space to accommodate each resident comfortably. Private resident bathrooms in rooms were inspected. Restrooms were clean, toilets and water faucets worked properly and were properly supplied, have functional fixtures and have secure grab bars, showers were free of mold/ mildew and most had non-skid mats or strips in place. Hygiene supplies are provided. Water temperature was measured in random resident’s rooms and temperatures ranged from 109.4 to 113.5 degrees F. which is within range of 105.0 – 120.0 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately available. The fire alarm system requires maintenance as it could not be heard in the entire building. Some rooms had smoke alarms that were not operable at the time of visit. One room has a missing door on the bathroom vanity and the bathroom shelf was uncleaned.

Planned Activities: Calendars and supplies for activities were observed in the activity room.

(Continued on 809C)

Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. Additional food supply was also observed. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. The kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept clean and stored properly. The dining room has adequate seating. Posted menu observed.

Health Related Services/Incidental Medical Services: The medications are centrally stored in the office/ medication room and in bubble packs and/or original containers. LPA reviewed medication for R1-R5. The facility uses the Medication Administration Records (MARs) to document medications given to residents. Medications are administered as prescribed by the Physician. The facility provides incidental medical services.

Per Title 22 Regulations, there were deficiencies observed during the visit. Technical Advisory issued.

An Exit interview and a copy of this report were provided to Zara Poghosyan, Director of Operations along with appeal rights.