Glenoaks Senior Garden

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted the required annual inspection. LPA was allowed entry by Marijan Tekeian, Family member and explained the purpose of today's visit. Administrator/Licensee Diana Tekeian is unavailable and out of town. At, 10:10am, Ana Papazyan, Marketing Manager arrived and assisted LPA with the inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan. Infection Control Plan was not reviewed as Marketing Manager cannot locate the file. Common area surfaces are being cleaned and disinfected on a regular basis. Bathrooms have soap and paper towels. Staff will adhere to infection control requirements. Operational Requirements: A current Plan of Operation was not reviewed, as Marketing Manager cannot locate the file. A fire clearance is in place. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and #3,000,000.00 in the total annual aggregate is valid and will expire on 6/18/2024. No fire drill has been conducted yet. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood that is licensed to serve 5 ambulatory residents ages 60 and over, of which (1) may be bedridden and (1) may be non ambulatory in bedroom #3. There is also a hospice waiver for (2). There is zero (0) resident in the facility during the visit. Home consists of three (3) bedrooms, (2) bathrooms, living room, dining room, family area, kitchen, backyard, and a detached garage. The fireplace in the living room is adequately screened. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Currently, there is a construction going on in the front yard and the back yard. According to the Marketing Manager, the on-going construction is to fix plumbing issues and landscaping. Smoke and carbon monoxide detectors are operational. The facility has (2) fire extinguishers in the facility that are fully charged, one mounted on the wall in the living room and the other one in the kitchen. Cleaning supplies and toxic substances are stored in a locked cabinet. At 9:45am, hot water temperature readings measured 111.7 deg F in bathroom #1 and 108.1 deg F in bathroom #2 which are within the required 105-120 degrees Fahrenheit. ***CONTINUED ON LIC 809-C*** Staffing: There are zero (0) staff associated to the facility and additional staff will be hired according to the Marketing Manager. There will be (3) total staff members including the Administrator who will provide care and supervision to the residents. Additional staff will be hires as needed. LPA notified the Marketing Manager that staff to be employed should be over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. TAs issued. Personnel Records-Training: Administrator certificate is valid and will expire on 12/19/2023. No staff files were reviewed as there were no staff employed during the visit. LPA informed the Marketing Manager that future staff to be employed who will provide care and supervision to the residents should have the required training and associated to the facility. TA was issued. Resident Records-Incident Reports: No resident files were reviewed during the visit. Resident Rights-Information: Resident personal rights are posted. Planned Activities: There is sufficient space to accommodate indoor activities. However, due to the on-going construction at the facility, outdoor activity area is inaccessible and there is no covered space and furniture available for future residents. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Incident Medical and Dental: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in locked cabinet near the dining area which are inaccessible to residents. However, the non aspirin tablets expired on 8/2023. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Pursuant to Title 22, deficiencies were cited on the attached 809D and Technical Assistance were issued. An exit interview was conducted and a copy of the report was provided to the Ana Papazyan-Marketing Manager.the state’s words, verbatim · CDSS document, Oct 3, 2023

The state marks this report as 10 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Christine Wong, Benette Pena, Ashley Calderon, Valeria Maldonado conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to CCLD on 12/17/21, for initial license for a Residential Care Facility for the Elderly, to serve 60 years and older. The requested capacity is for 5 ambulatory, of which 1 maybe bedridden and 1 maybe non-ambulatory in bedroom#3. Structure: Facility is a 3 bedrooms, 2 bathrooms, single story house with a detached two cars garage. The facility consists of sitting room, dining area, living room, kitchen. The home has a gas fire place in the living room with a metal screen cover, and is inaccessible to residents. There is a large back yard with shaded area with tables and chairs for residents to use. The residents bedrooms are spacious and will easily accommodate the residents furnishings. . The exit and passageways are free from obstructions. The front, back and side areas of free of hazards and debris. Bedrooms Residents: There shall be no more than two residents per bedroom. Bedrooms#3 is for non-ambulatory residents. Bedroom #1 and #3 have two beds, two chairs, two night stands, closet. Bedroom#2 has one bed, one chair, one night stand and closet. Bedrooms Staff: No bedroom designated for awake-staff. Bathrooms: All bathrooms have a working toilet, wash basin and shower. There is one bathroom that will accommodate non-ambulatory residents in a wheel chair. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in linen closet next to the pantry. . Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review on the wall near the dining are. Fire Extinguisher located between kitchen and living room mounted on wall. The facility has a landline and the telephone number is 818-726-4871. Food Service: Dishes, cups and flat ware are stored in the kitchen cabinet, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are locked in the lock box and stored in the kitchen cabinet. Food supply adequate stored in the kitchen and the pantry and consists of the following: minimum two days perishable and seven days non-perishable. Dishwasher in kitchen properly installed and functioning. Smoke Detectors: All the smoke detectors and carbon monoxide detectors are interconnected and located in each bedroom and common area. Appliances: Refrigerator, Stove burners, oven, microwave are working properly. Each refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. Toxins: Locked/stored in the garage Water Temperature: The hot water temperature in two bathrooms were measured between 106.4 and 109.9 degrees F. Medications, First-Aid Kit & Book: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in locked cabinet near the dining area, available for staff use but inaccessible to residents. Clients & Staff Files: All the staff and resident files are stored in a locked cabinet near the dining area Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the resident's use, commensurate with the plan of operation. Fire clearance: Fire Clearance with bedroom#3 is approved for non-ambulatory and bedridden in use was approved on 03/17/22 For the washing machine, dryer and the blind/curtain are currently unavailable in the facility, they have already ordered and LPAs also obtained the copy of the receipt of the order. The applicant will take a picture and send to LPA via email once the appliances arrived. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. An exit interview was conducted and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, May 4, 2022

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 5 Census (if any clients in care): 0 COMP II Participants: Diana Tekeian Interview Method: Telephone interview On April 04, 2022, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 4, 2022