Grant Serenity Homes of SF Valley

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit at 9:20am. Upon arrival LPA met with Administrator Ruzanna Sukiassyan and explained the reason for the visit. At approx. 09:50am, 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. Facility is a single-story residence and consists of a total of six (6) bedrooms and one (1) bathroom. During physical plant tour LPAs observed the required postings throughout the facility. At approx. 9:30am, LPA observed resident having breakfast. The kitchen appeared to be clean and the appliances and fixtures functional during the time of visit. LPAs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are stored in a cabinet in the kitchen to the right of the stove. No cleaning supplies or toxins are stored under the sink. Laundry room located to the left of the fridge. It was observed to be inaccessible to residents in care at the time of the visit. LPA observed cleaning supplies and other toxins stored in this location. Non-perishable food panty located to the left of the laundry room. It was observed to be inaccessible to residents in care. LPA observed a sufficient supply of extra non-perishable food stored in this location. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed bathroom to be clean, properly supplied and had functional fixtures. LPA observed bathroom to have grab bars and non-skid mats. The hot water was measured in each bathroom between 110 - 113 degrees Fahrenheit. Continued from 809 LPA observed common areas which, included the living room, office area and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Planned activities and games were on display on a shelf located near bedroom #2. Medications are stored in a locked cabinet and locked fridge near the office area. LPA observed both to be inaccessible to residents in care. There is a dedicated area for the posting of required documents directly by the entry way into the kitchen. The common areas were observed to be properly furnished and relatively clean at the of the visit. LPA observed appropriate signage regarding infection control posted throughout the facility. LPA observed sanitizer readily available in areas with high touch surfaces. Common room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were observed fully charged and last serviced on 12/29/2022. Between 09:50am - 10:40am LPA observed an entertainer singing with all the residents. All exits in the facility have functioning auditory devices and were operational at the time of the visit. LPA observed the back patio, with a shaded area and appropriate outdoor furniture for resident use. LPA observed a detached garage. Disinfectants, cleaning solutions, incontinent supplies are stored inaccessible to residents in this area. LPA also observed 7 day emergency food supply kept in the garage as well. Storage room in the rear of the garage was observed to store a sufficient amount of PPE. Behind the garage LPA observed (3) buildings for storage. The building closest to the detached garage was observed to store art pieces. The other (2) storage buildings at the rear of the facility stored decorations, medical equipment, other supplies for facility use and extra art pieces. Next to the detached garage LPA observed an empty pool that was gated and inaccessible to residents in care. The outdoor area behind the detached garage is inaccessible to residents in care at this time. There is a gate on the side of the facility designated for an emergency exit. Passageways were free and clear from obstruction. LPA observed shaded seating area with appropriate outdoor furniture in the front of the facility as well. Records review began at 10:30 am, five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At approx. 11:30am, Five (5) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were observed to be in order at this time. Continued from 809-C Medications: Medications review began at approximately 01:00pm. The medications are centrally stored in a locked storage cabinet near the office area. Medications were observed to be properly documented on the centrally stored medications and destruction record. Infection Control : Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of a communicable disease. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room or relocate residents if the facility has a confirmed case of a communicable disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time. Between 2pm - 2:30pm the LPA interviewed three (3) staff members and attempted to interview five (5) residents. LPAs obtained the following documents - Census, Staff schedule, Administrator Documents and updated Limited Liability insurance. Exit interview conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Oct 5, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. LPA was greeted and screened by staff. LPA explained the reason for the visit to Licensee Nvard Gevorkian. This annual had a specific emphasis on infection control practices and procedures. At approximately 10am, 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. Fire extinguishers were observed fully charged and last serviced in September. LPA observed the kitchen/dining area to be clean at the time of the visit. Knives are stored in a locked drawer to the right of the stove. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable food properly stored. Non-perishable food was observed kept in a locked pantry room inaccessible to residents in care. Laundry room was located next to pantry room and it was observed locked and inaccessible to residents in care. 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 were observed to be relatively clean, sanitary and in operating condition with grab bars and non-skid mats. Hot water measured between 105 - 120 degrees Fahrenheit. LPA observed common area to be relatively clean and properly furnished. There is a fireplace that is adequately screened. LPA also observed puzzles and different activities for the residents. At approximately 10:30am, LPA observed (2) residents watching television in the living room. There is an office area to the right of the kitchen. Medications were observed stored in a locked cabinet and locked fridge outside of room 3 inaccessible to residents in care. Continued from LIC 809. LPA observed the back patio, with a shaded area and appropriate outdoor furniture for resident use. LPA observed a detached garage. Disinfectants, cleaning solutions, incontinent supplies are stored inaccessible to residents in this area. LPA also observed 7 day emergency food supply kept in the garage as well. Storage room in the rear of the garage was observed to store a sufficient amount of PPE. Behind the garage LPA observed (3) buildings for storage. The building closest to the detached garage was observed to store art pieces. The other (2) storage buildings at the rear of the facility stored decorations, medical equipment, and other supplies for facility use. Next to the detached garage LPA observed an empty pool that was gated and inaccessible to residents in care. The outdoor area behind the detached garage is inaccessible to residents in care at this time. There is a gate on the side of the facility designated for an emergency exit. Passageways were free and clear from obstruction. LPA observed shaded seating area with appropriate outdoor furniture in the front of the facility as well. INFECTION CONTROL: The LPA spoke with Nvard regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate each resident to their private room if the facility has a confirmed case of COVID-19. COVID-19 testing will be conducted twice a week if there are any COVID-19 concerns. The facility’s policies and procedures as it pertains to infection control are adequate at this time. No deficiencies were observed at this time. Exit interview conducted. Report issued and a copy of the report was provided via email.the state’s words, verbatim · CDSS document, Sep 23, 2022

Allegation investigated: Facility is not following COVID -19 masking requirements. Facility is not screening visitors for COVID -19.

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint investigation for the allegations listed above. Upon arrival LPA met with Nvard Gevorkian and explained the reason for the visit. At approximately 9:30am, LPA conducted physical plant, interviewed staff and residents as well as reviewed and obtained copies of pertinent documents relevant to the investigation. It was alleged that facility is not following COVID-19 masking requirements. Regional office received information from a credible witness that while visiting the facility, they observed that some caregivers were not wearing masks. Upon arrival to the facility, LPA observed all staff wearing masks. However, LPA nterview with the licensee and Staff 1 (S1) revealed they recently had a visit from an outside agency who observed S1 not wearing a mask while working with the residents. Based on interviews, the allegation of "Facility is not following COVID-19 masking requirements is deemed SUBSTANTIATED at this time. Continued on 9099-C Substantiated Continued from 9099 It was further alleged that facility is not following COVID-19 screening protocols. Upon entering the facility, the LPA was screened at the door and temperatures were taken by Staff. Additionally, LPA’s observed a Home Health nurse coming into the facility at approximately 9:45am. LPA record review revealed that the Home Health nurse had not signed into the visitor’s log showing that they had been screened for COVID-19. During staff interviews, staff reported that they were busy and had forgotten to have nurse sign in. Based on interviews and record review, the allegation of “facility is not following COVID-19 screening protocols” is deemed Substantiated at this time. Citations Issued. See LIC 9099D. Appeal Rights discussed. Exit interview conducted and copy of the report emailed to Administrator.the state’s words, verbatim · CDSS document, Aug 18, 2022 · control 29-AS-20220811082941

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Aug 19, 2022

87468.1(a)(2) Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations... This requirement is not met as evidenced by: Based observations and interviews, the Licensee did not ensure the personal rights of persons in care to live in a safe, healthy, and comfortable home as staff did not wear face coverings at all times while inside the facility and did not follow COVID-19 infection screening protocol, which poses an immediate health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Aug 18, 2022

Plan of correction: The Licensee agreed to advised staff on wearing masks at all times inside the faciltiy and conduct a training on CA Dept of Public Health Guidance for the use of face coverings and COVID-19 screening protocols and submit proof to LPA via email by end of day 8/19/2022.

Type of visit: Required - 1 Year

At 2:00 p.m., Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. LPA was greeted and screened by staff. LPA explained the reason for the visit to Licensee Nvard Gevorkian. This annual had a specific emphasis on infection control practices and procedures. At 2:20 p.m., 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: At 2:32 p.m., LPA observed the kitchen/dining area. Knives are stored in a locked cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 2:28 p.m., hot water measured at 105.8-degree Fahrenheit. BEDROOMS: 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 2:29 p.m., hot water measured at 106.9-degree Fahrenheit. COMMON AREAS: LPA observed common area to be relatively clean and properly furnished. There is a fireplace that is adequately screened. Medications are in a locked cabinet located in the common living area. LPA also observed puzzles and different activities for the residents. Continued on LIC 809-C. Continued from LIC 809. OUTDOOR SPACE: At 2:26 p.m., LPA observed the back patio, which has a covered outdoor area for resident use. Disinfectants and cleaning solutions are stored inaccessible to residents in the garage area. There is a gate on the side of the facility designated for an emergency exit. Passageways were free and clear from obstruction. INFECTION CONTROL: During today’s visit, the LPA spoke with the Licensee regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. Between 2:00 p.m. - 2:30 p.m., LPA conducted Infection Control mitigation module with Licensee. No deficiencies were observed at this time. Exit interview conducted. Report issued and a copy of the report was provided via email.the state’s words, verbatim · CDSS document, Sep 21, 2021