At 10:40AM, LPA spoke with Administrator - Ms. Heghine Avetisyan over the telephone. Administrator stated that she can not come to the facility today but designated Staff Yelena Grigoryan to sign the report.

At 11:45am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the living room. Facility has multiple exit doors but uses the entry door and the exit door in the family room, as the main exits. There are clearly marked exits sign above all exit doors. The smoke and carbon monoxide detectors are hardwired and interconnected. At 11:48am smoke/carbon monoxide detectors were tested and observed to function properly. The fire extinguishers are located in the kitchen and in the living room, both fire extinguishers were serviced on 04/28/2025.

Kitchen: The kitchen appliances and work surfaces are clean and sanitary. Appliances consisted of a stove, dishwasher, microwave, refrigerator and a small freezer. There is a dining set on one corner of the kitchen. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. LPA observed emergency water supplies in the kitchen as well. Knives and sharp objects were stored in a locked drawer in the kitchen and chemicals were observed to be locked, underneath the sink.

Continued on 809-C

• 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.

Bedrooms: There were three (3) shared bedrooms designated for residents' use. All of the bedrooms were were properly furnished with appropriate beds, chairs, closets and linens with sufficient lighting. Bedrooms #1 and #2 have exit doors, leading to the backyard. Bedroom # 2 has it's own private bathroom.

Bathrooms: There are two (2) full bathrooms designated for residents' use. Both bathrooms had required functional fixtures, grab bars and non-kid mats. Hot water temperature was measured between 112.8 and 115.0 degrees Fahrenheit.

Surrounding Grounds: There are no bodies of water present. Facility has multiple exit doors but uses the main entry and the exit door in the family room, as the main exits. All walkways and exit passages were free of obstruction. There is a covered patio with two sets of furniture, appropriate for outdoor use. There is a detached garage, which was converted to a staff room.

Laundry Area: Washer and dryer are located inside the main bathroom. Chemicals, detergents and the laundry machines are separated by a locked door and are kept inaccessible to residents.

Medications/Resident Files: All resident records and medications are kept locked in a kitchen cabinet. Medications for all 4 residents were counted and records were reviewed for accuracy of administration, based on physician orders. LPA conducted a file review of all 4 resident records to ensure compliance of licensing forms and current physician records.

Staff Files: LPA conducted a file review of staff records to ensure forms and training are up to date and compliant with licensing forms.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / A Copy of the Report Issued to the Staff.