Sweet Home Senior Living 1 Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 12:17PM. The LPA met with the Licensee Lusine Srmikyan and Coordinating Manager (CM) Marine Bekyan and informed them of the reason for the visit. Entrance interview conducted. Beginning at 12:42PM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The facility is a single-story residential home on shared property with other related facilities. The following was observed: KITCHEN: The LPA observed knives and medications stored inaccessible in a locked drawer and cleaning supplies secured under the sink. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food and water stored in the office. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. Grocery shopping occurs every two (2) weeks, sometimes more when needed. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. Required postings were observed on the entryway wall. The facility maintained a comfortable temperature throughout the visit. Nightlights were observed throughout the hallways. There was a closet located in the hallway which contained laundry machines in operating condition. BEDROOMS/RESTROOMS: There were three (3) total bedrooms, each private. Bedrooms #1 and #3 had a direct exit to the outside and approved for one (1) bedridden resident. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Extra linens were stored in each bedroom. There were two (2) total restrooms in the facility: one (1) private and one (1) shared. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hygiene products were secured in each restroom. Hot water was tested and measured between 118.8 degrees F and 119.3 degrees F which is within the required range per regulation. OUTDOOR AREA: The front yard had a shaded patio area equipped with furniture in good condition for resident and visitor use in addition to a secured shed with general storage. The front yard also led to the subsequent facility with one (1) emergency exit on the side. The sides of the property contained general storage and were secured by gates. Exits and passageways were free of obstruction. The facility had additional gates with access to the neighboring three (3) facilities that the Licensee also operates. MEDICATIONS: Medication review began at 1:05PM. Medications were centrally stored and kept inaccessible in the kitchen. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Report Continued on LIC 809-C RECORDS: Record review began at 1:39PM. Resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Fire extinguishers were observed throughout the facility and were last serviced on 05/16/2025. Emergency disaster drills are conducted quarterly, with the last documented drill on 12/18/2025. Smoke and carbon monoxide detectors as well as fire doors were tested at 1:02PM and were operational. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Jan 13, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 1:24 p.m. Upon arrival, LPA Mosley was greeted by staff and Coordinating Manager. The LPA met with Marine Bekyan – Coordinating Manager and explained the reason for the visit. Lusine Srmikyan Licensee Representative was called and informed of the reason for this visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA inspected the kitchen/food service area at 1:30 p.m. Knives and sharps were observed in a locked cabinet. Kitchen appliances were in operable condition. Chemical storage is kept locked under the sink. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 117.1 degrees Fahrenheit at 1:33 p.m. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 1:39 p.m., hardwire combination of smoke / carbon monoxide detector and fire doors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 05/15/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 12/20/2024. Activities were observed in the common areas. There is a laundry area with a washer and dryer. Laundry detergent was observed in a locked cabinet under the sink. Report Continued on LIC 809C... Report Continued from LIC 809... RESTROOMS: There are Two (2) resident restrooms. One (1) is designated for private resident use and one (1) is a shared resident use. Resident restrooms were observed to be equipped with nonskid surfaces. Grab bars were observed in the bathrooms. The restrooms were sufficiently stocked with supplies and paper towels. The water temperature was measured in both resident restrooms from 1:32 p.m - 1:35 p.m and measured between 115.5-117.4 degrees Fahrenheit and within the required range. BEDROOMS: There are three (3) total bedrooms in the facility; All three (3) are currently designed as private resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. GARAGE/BACKYARD: The garage is designed as the office and is maintained locked at all times. LPA observed an adequate amount of emergency food and water. Cleaning supplies are kept in the garage locked and inaccessible to residents in care. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. MEDICATIONS: Medications review began at approximately 2:44 p.m. The medications are in a locked drawer in the kitchen. Medications for three (3) residents were reviewed. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. RECORDS: Record review began at approx. 1:45 pm. Resident Records were reviewed beginning at 1:45 p.m. Three (3) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Personnel Records were reviewed beginning at 2:00 p.m. Four (4) Personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Report Continued to LIC 809C... Report Continued from LIC 809C... INTERVIEWS: Two (2) staff interviews, and One (1) resident interview was conducted during the inspection. Staff interviews revealed that staff are knowledgeable in Resident right, different forms of abuse and reporting procedures. Resident interviews revealed that no concerns were voiced or noted at the time of the visit. LPA obtained the following documents LIC 500 Personnel Roster, LIC 9020 Resident Roster, and current liability insurance. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 01/27/2024. At 12:35 p.m., the LPA met with the Licensee and Coordinating Manager and explained the reason for the visit. RECORD REVIEW: Starting at 12:44 p.m., the LPA reviewed resident records for four (4) out of four (4) residents. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. All files were in order. The LPA conducted a personnel file review for all staff regularly scheduled and reviewed for, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Personnel files reviewed were observed to be in compliance. At 2:28 p.m., the LPA conducted a review of medication and medication documentation with the Licensee for four (4) residents. No errors observed during the medication review. At 2:29 p.m., the LPA conducted a brief physical plant tour to ensure there are no health and safety hazards. No deficiencies cited at this time. Exit interview conducted. A copy of the report of provided.the state’s words, verbatim · CDSS document, Jul 11, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:55 a.m. the LPA met with the Licensee and explained the reason for the visit. At 9:56 a.m., 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 the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 9:56 a.m., hot water measured at 114.7-degree Fahrenheit. Medications and first aid kits are located in a locked kitchen drawer. BEDROOMS: The facility is a single-story residential home with three (3) bedrooms and two (2) bathrooms for resident's use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 9:57 a.m., hot water measured between 110.0 and 115.2-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout bathrooms and facility to promote handwashing. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 05/01/2023. At 9:59 a.m., fire alarms/ carbon monoxide detectors were tested and functioned properly. Laundry units are located in one of the hallways. Night lights were present in the hallways and passages. Continued on LIC 809-C. OUTDOOR SPACE: At 10:00 a.m., the LPA observed the front patio which has a covered outdoor area for resident use. There is a gate at the front of the house designated for an emergency exit. There are no bodies of water on the premises. Starting 10:07 a.m. the LPA conducted interviews with one (1) staff and one (1) resident. The Administrator’s certificate is active and expires on 03/16/2025 Due to time constraints the LPA will return to complete the annual at a later date. No deficiencies were observed at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 27, 2024