Northridge Gardens Board & Care

Type of visit: Required - 1 Year

On 7/12/23 Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Gayane Khachaturova and staff Narine Sahakyan and Gayane Arakelyan. They were advised of the reason for the visit. At 9:30 am, with the assistance of Administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detectors are dual. Smoke alarms are hardwired and interconnected. The fire extinguisher is located in the kitchen.It was purchased on 5/8/23. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in a closet by the kitchen. Bedrooms: There were (5) bedrooms designated for residents' use. All five rooms are for private use. All rooms were properly furnished with appropriate beddings and linens with sufficient lighting. There is also a sufficient supply of linen and towels stored in the linen closet. Bathrooms: There are two (2) bathrooms designated for residents' use. One (1) bathroom is attached to a private room. All the bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured and it ranged between 110-117 degrees Fahrenheit. LPA observed a bottle of Colrox cleaning solution under bathroom cabinet and was accessible to residents in the bathrooms. Administrator immediately took the bottle and stored away from residents. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Garage/Storage Room: LPA observed garage/ storage room door class is broken and unlocked. Upon entrance LPA observed the laundry area, and cleaning solutions are on the floor and accessible to residents. LPA advised Administrator of the immediate health and safety hazard of this area. Administrator immediately started to fix the broken door and lock the room. Temperature:of facility wall thermostat was set at 76.0°F and observed to be within the required range. (Continue on 809C) During the annual inspection, LPA observed the following deficiencies: 1) Clorox spray bottle in the cabinet bathroom accessible to resident. 2) Licensee is not complying with medication log. Medication sheet is empty and staff don't record type, date and time of medication been taken. 3) Garage/Storage door is broken and unlock. The storage are has cleaning solutions accessible to residents. Deficiencies are cited on LIC 809D Exit interview conducted, appeal rights, and copy of the report given.the state’s words, verbatim · CDSS document, Jul 12, 2023

Type of visit: Case Management - Deficiencies

At 9:00am, LPA conducted an unannounced Case Management Visit to this facility. LPA met with the Administrator and explained the reason for the visit. Entrance interview conducted. After review of complaint #31-AS-20221215161509, a deficiency was issued on 12/20/2022. In addition, on 05/26/22 the facility was issued another deficiency for the same violation and it had been determined that a civil penalty should be assessed. During todays visit a Civil Penalty was issued. Exit interview conducted, appeal rights explained and copy of this report provided to the Administrator.the state’s words, verbatim · CDSS document, Jan 6, 2023

Allegation investigated: Staff made harmful items accessible to the residents while in care Staff mishandled the residents medications while in care

At 11:20am, Licensing Program Analysts (LPA) Angela Pnaushkina conducted an unannounced complaint visit to investigate the above noted allegation. LPA met with the Staff #1 (S1) and Staff #2 (S2) who granted access to the facility. Administrator was contacted and LPA explained the reason for the visit. Administrator arrived at 1:45pm. It was alleged that "Staff made harmful items accessible to the residents while in care." To investigate this allegation, LPA conducted a physical walk though of the facility, interviewed Administrator and two (2) staff members between 11:30am-1:00pm. LPA also obtained copies of pertinent documents relevant to the investigation. Upon arrival at 11:20am, LPA observed kitchen drawer with knives and sharp objects unlocked. LPA observed the lock on the kitchen drawer was broken and requested to change it, immediately. Continue on LIC9099-C Substantiated In addition, interviews with the Administrator confirmed that on November 30th, 2022, a random visit was made by a credible witness who observed an unlocked drawer in the kitchen containing knives and scissors Administrator informed LPA that an additional training will be provided to all facility staff members. Based on an interview conducted with the Administrator and LPA's observation this allegation is Substantiated at this time. It was alleged that "Staff mishandled the residents medications while in care." Upon arrival, LPA observed the medication cabinet in the kitchen was unlocked and accessible to residents in care. Staff #1 (S1) immediately locked the medication cabinet. Based on the LPA's observation this allegation is Substantiated at this time. Deficiencies were issued per CA code of Regulations Title 22 on LIC9099-D with this report. Appeal rights issued. Report signed and delivered. Exit interview conducted.the state’s words, verbatim · CDSS document, Dec 20, 2022 · control 31-AS-20221215161509

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(1)(2) · Plan of correction due date: Dec 22, 2022

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents...(1) Knives, matches, firearms...(2) Over-the-counter medication... cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by providing care and supervision to persons with dementia and having knives and cleaning solutions/chemicals unlocked and accessible to residents in care, which poses an immediate health and safety or pesonal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2022

Plan of correction: Administrator will provide a training to all staff on the importance of maintaining knives and chemical items inaccessible to residents in care. The administrator shall submit staff sign in sheet with the topic and the training material to LPA by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Dec 22, 2022

87465 Incidental Medical and Dental Care. (h)The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above by keeping centrally stored medication cabinet unlocked, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2022

Plan of correction: Licensee shall conduct in-house training with Administrator and all staff regarding regulation above. A written statement acknowledging the completion of training shall be submitted to the LPA by POC date

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced case management visit at this facility to issue deficiency in conjunction with complaint control # 31-AS-20221215161509, wherein during the course of investigation regarding this complaint, LPA observed the following: Upon arrival, LPA checked Licensing Information System (LIS) and observed Staff #1 and Staff #2 were not fingerprinted and or associated with this facility. Citation issued on LIC809-D and appeal rights discussed. Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Dec 20, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Dec 21, 2022

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. S1 and S2 were not associated to the facility which poses an immediate health, safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 20, 2022

Plan of correction: Administrator has agreed to either have the staff get fingerprinted or submit the request for transfer. Administrator will provide an updated LIC500 to reflect new staff.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Shira Stamps met with Administrator Gayane Khachaturova for an unannounced one (1) year Required visit for this facility. LPA arrived at 10:40am and was greeted by caregiver Angin Tovmasyan. Two (2) residents were observed in the living room watching TV. The rest of the residents were observed to be in their room sleeping, watching TV and/or resting. The Administrator arrived at 10:45am. LPA informed the Administrator of the purpose of the visit. Entrance Interview conducted. A tour of the physical plant was conducted with Administrator at 10:50am. The facility has five (5) bedrooms and two (2) bathrooms currently occupying five (5) residents. Infection control: LPA reviewed the facility mitigation plan (approved on 03/12/21) to make sure licensee was following current infection control recommendations. Upon arrival LPA was screened by caregiver Angin and was asked to sign-in. Sanitizer was made available. Food Inspection LPA conducted a tour of the kitchen at 10:50am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed one knife sitting in the drying rack in the kitchen sink.The Administrator immediately locked the knife in the draw. LPA observed all other knives and sharp object being locked and inaccessible to residents in care. CONTINUED...the state’s words, verbatim · CDSS document, May 26, 2022

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

An unannounced Collateral Visit in conjunction with a Subsequent Complaint visit was conducted on this day by Licensing Program Analyst (LPA )Yelena Avetisyan. The purpose of this visit is to Deliver complaint investigation findings for a complaint filed against Lake Balboa Board & Care (Complaint Control # 31-AS-20200211152628) Facility # 197609114 which is no longer operating. The licensee/Administrator for this facility Gayane Khachaturova was identified as the Operator for Lake Balboa Board & Care. Upon arrival LPA met with Staff Anna Pirumyan and Angin Tovmasyan. Ms. Pirumyan contacted Ms. Khachaturova who arrived at the facility approximately 12:20 pm. While waiting at the facility the LPA conducted a brief tour of the facility with staff Pirumyan. Upon arrival to the home LPA observed a Permit issued for an ADU to be built. LPA informed Ms. Khachaturova that she will need to submit written plan to the department/LPA regarding their plans. Exit interview conducted and copy of report emailed to the GAYANA79@HOTMAIL.COMthe state’s words, verbatim · CDSS document, May 22, 2022