Ana's Residence Care 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:15 AM. LPA met with facility staff who contacted the facility Administrator Anna Atayan. The Administrator arrived to the facility at 10:44 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:45 AM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. LPA observed a secured cabinet that contained resident medications. The kitchen contained the facility’s washer and dryer. LPA observed the door to the garage to be locked and inaccessible to clients in care. LPA observed a cameras covering the kitchen and common areas. LPA confirmed with the facility Administrator that audio is not recorded. COMMON AREAS: This included the living room, hallway, and dining area. LPA observed all common areas of the facility to be clean and all furniture was observed to be in good repair. The living room contained a television, activities, and adequate seating for resident use. LPA observed the hallway closets to contain extra linens and care supplies. LPA observed the dining area to contain adequate seating for resident use. LPA observed fire extinguishers located in the dining area and hallway. Fire extinguishers were observed to be fully charged and purchased on 02/27/2026. The facility’s combination fire and carbon monoxide alarms, as well as the facility fire door, were tested at 01:26 PM and were functional at the time of the visit. CONT... INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 03/26/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents and two (2) staff members. Both residents interviewed stated that the staff treat them well and are attentive to their needs. Both residents had no concerns with the facility. Both staff interviews were conducted with the assistance of the facility Administrator acting as a translator. Both staff members interviewed understood their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, emergency disaster plan, and liability insurance. No deficiencies were observed during today’s inspection. Exit interview conducted and copy of the report was issued. BEDROOMS: There are seven (7) bedrooms in the facility; six (6) bedrooms are single occupancy rooms and one (1) is a staff bedroom. LPA and facility Administrator toured all six (6) resident rooms. All resident rooms were observed to be clean and were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on facility exits and all were functional at the time of the visit. Bedrooms # 2,3,4,5, and 6 all contain direct exits to the outdoors of the facility. LPA observed the staff bedroom to be secured from clients in care. BATHROOMS: There are four (4) bathrooms at the facility. Two (2) bathrooms are designated as private resident bathrooms, and two (2) bathrooms are designated as shared resident bathrooms. All resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be 109.4 degrees Fahrenheit, which is in compliance with regulation. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard; LPA observed clear passageways on either side of the facility for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the backyard to contain ramps and handrails leading from the exits of resident rooms. All ramps were observed to be in good repair and all handrails were properly secured. LPA observed cameras located throughout the outdoors of the facility. GARAGE: LPA observed the garage to be inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, emergency water supplies, file storage, and an extra refrigerator. RECORD REVIEW: Record review began at 11:07 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained the required documents and trainings. Six (6) resident files were reviewed all resident files contained all required documentation and signatures. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 12:53 PM. Medications for three (3) of six (6) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. CONTINUED ON LIC 809C.the state’s words, verbatim · CDSS document, Apr 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:28 AM. LPA met with facility staff who contacted the facility Administrator Anna Atayan. The Administrator arrived to the facility at 09:49 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:50 AM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed a secured cabinet to contain resident medications. The facility’s washer and dryer are located in the kitchen and a door to the garage was observed to be locked and inaccessible to clients in care. LPA observed a camera covering the kitchen area and entrance to the garage. LPA confirmed with the facility Administrator that audio is not recorded. GARAGE: LPA observed the garage to be inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, emergency water supplies, and an extra refrigerator. Continued on LIC 809C. COMMON AREAS: This includes the living room, Administrator’s office, hallway, and dining area. LPA observed all common areas of the facility to be clean and all furniture was observed to be in good repair. The living room contains a television, activities, and adequate seating for resident use. The Administrator’s office is located at the front of the facility and contains facility and resident files. LPA observed a hallway closet to contain extra linens and care supplies. The dining area is attached to the kitchen and contains adequate seating for resident use. LPA observed the dining area and hallway to contain fire extinguishers. Fire extinguishers were observed to be fully charged and purchased on 02/24/2025. The facility’s combination fire and carbon monoxide alarms, as well as the facility fire door, were tested at 10:23 AM and were functional at the time of the visit. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front yard; LPA observed clear passageways on either side of the facility for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the backyard to contain ramps and handrails leading from the exits of resident rooms. All ramps were observed to be in good repair and all handrails were properly secured. BEDROOMS: There are six (6) bedrooms in the facility; all six (6) bedrooms are single occupancy rooms. LPA and facility Administrator toured all six (6) resident rooms. All resident rooms were observed to be clean and were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. One (1) resident bed was observed to contain full bed rails. Auditory alarms were observed on facility exits and all were functional at the time of the visit. Bedrooms # 2,3,4,5, and 6 all contain direct exits to the outdoors of the facility. BATHROOMS: There are four (4) bathrooms at the facility. Two (2) bathrooms are designated as private resident bathrooms, and two (2) bathrooms are designated as a shared resident bathrooms. All resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured between 106 and 109 degrees Fahrenheit, which is in compliance with regulation. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:25 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed all resident files contained all required documentation and signatures. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 11:25 AM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 03/21/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents and two (2) staff members. Both residents interviewed stated that the staff treat them well and are attentive to their needs. Both residents had no concerns or recommendations for improvement for the facility. Both staff interviews were conducted with the assistance of the facility Administrator acting as a translator. Both staff members interviewed understood their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. No deficiencies were observed during today’s inspection. Exit interview conducted and copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Anna Atayan arrived shortly thereafter. The LPA and the Administrator 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. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained an average comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and purchased 01/20/2024. The LPA observed required postings throughout the common space. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The facility has six (6) single-occupancy resident bedrooms and one office. All bedrooms have direct exits with a ramp to the outside. Resident rooms are equipped with required furnishing and are well lit. There was a linen closet in the hallway with extra towels and linens, and incontinent supplies. KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature was tested and found to be within the range of 105*F and 120*F. The smoke detectors and carbon monoxide detectors were tested and functioned properly during the time of visit. The washer and dryer are found in the kitchen area. Continues on LIC 809C... BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. There are four (4) full bathrooms in the house. Each have roll-in showers with non-skid mats and grab bars. The hot water temperature was tested and found to be within the range of 105*F and 120*F. OUTDOOR AREA/ATTACHED GARAGE: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. The side gat is free of obstructions. No bodies of water noted. Cleaning supplies are stored in the locked garage. RECORDS: Records review began at 12:30 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, 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 files were in order. MEDICATIONS: Medications review began at 1:30 p.m. Medications are centrally stored and locked in a cabinet in the kitchen area; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: 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 if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 20, 2024