Blue Horizon Eldercare

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 09:59 AM. LPA met with facility Administrator Zhanna Davtian. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:01 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: GARAGE: LPA observed the garage to contain two (2) secured cabinets which contained extra cleaning supplies and laundry supplies. LPA observed two (2) secured filing cabinets which contained facility files and resident medications. Additionally, LPA observed the garage to contain the facility’s washer and dryer, extra care supplies, extra linens, and adequate emergency food and water supplies. COMMON AREAS: This includes the living room, entryway, hallway, and dining area. LPA observed the living room to contain adequate seating, a television, and activities for resident use. LPA observed the entryway to contain all required postings and an infection control point with a thermometer. LPA observed a fire extinguisher mounted in the entryway to be fully charged and purchased on 02/24/2025. LPA observed the hallway to be clean and free from any obstructions. The dining area was observed to be clean and properly furnished at the time of the visit. The dining area contained a dining table with adequate seating for resident use. The facility’s combination fire and carbon monoxide alarms were tested at 10:22 AM and were functional at the time of the visit. Continued on LIC 809C. 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 to contain knives, utensils, and other sharp objects. LPA observed a locked under-sink cabinet to contain cleaning supplies and soaps. LPA observed a complete first aid kit with a first aid manual. BATHROOMS: There are two (2) bathrooms at the facility. One (1) bathroom is designated as a private resident bathroom, and one (1) bathroom is designated as a shared resident bathroom. Both 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 113.4 and 113.7 degrees Fahrenheit, which is in compliance with regulation. LPA observed both resident bathrooms to contain appropriately secured cabinets which contained personal grooming supplies for resident use. BEDROOMS: There are three (3) bedrooms in the facility; all are designated as dual occupancy rooms. LPA and facility Administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #2 contained a direct exit to the outside of the facility. Auditory alarms were observed on facility exits and all were functional at the time of the visit. OUTDOOR SPACE: The facility has one (1) emergency exit gate located in the front of the property; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed a total of five (5) window screens on the home to be in disrepair with broken/bent window screen frames. LPA informed the Administrator who agreed to perform required repairs/replacements to the identified screens. RECORD REVIEW: Record review began at 10:34 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. Five (5) 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. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 12:07 PM. Medications for five (5) 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 they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 10/06/2025. 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) resident and two (2) staff members. The residents interviewed stated that the staff treat them well and are attentive to their needs. The residents interviewed 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 different forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s updated LIC 500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:01 AM. LPA met with facility Administrator Zhanna Davtian. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:03 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: GARAGE: LPA observed the garage to be inaccessible to clients in care. The garage was observed to contain two (2) secured cabinets, two (2) secured filing cabinets, the facility’s washer and dryer, extra care supplies, and adequate emergency food and water supplies. The two (2) secured cabinets were observed to contain extra cleaning supplies and laundry supplies. The two (2) secured filing cabinets were observed to contain facility files and resident medications. COMMON AREAS: This includes the living room, entryway, and dining room. LPA observed the dining room to be clean and properly furnished at the time of the visit. The dining room contains a dining table with adequate seating for resident use. LPA observed a fire extinguisher mounted in the entryway to be fully charged and purchased on 03/05/2024. LPA observed the entryway to contain all required postings. The living room was observed to be clean and in good repair. The living room contained adequate seating and activities for resident use. The facility’s combination fire and carbon monoxide alarms were tested at 10:11 AM and were functional at the time of the visit. Continued on LIC 809C. 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, utensils, and other sharp objects. LPA observed the facility refrigerator to maintain forty (40) degrees Fahrenheit and the freezer to maintain zero (0) degrees Fahrenheit. BATHROOMS: There are two (2) bathrooms at the facility. One (1) bathroom is designated as a private resident bathroom, and one (1) bathroom is designated as a shared resident bathroom. Both 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 113.5 and 116.6 degrees Fahrenheit, which is in compliance with regulation. LPA observed both resident bathrooms to contain appropriately secured cabinets containing personal grooming supplies for resident use. BEDROOMS: There are three (3) bedrooms in the facility; all are designated as dual occupancy rooms. LPA and facility administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #2 contains a direct exit to the outside of the facility. Auditory alarms were observed on facility exits and all were functional at the time of the visit. OUTDOOR SPACE: The facility is the back house on the property and has one (1) emergency exit gate located in the front of the lot; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. RECORD REVIEW: Record review began at 09:40 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. Six (6) 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. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 11:28 AM. Medications for five (5) 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 10/03/2024. 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 one (1) resident and two (2) staff members. The resident interviewed stated that the staff are nice, treat them well, and are attentive to their needs. The resident had no concerns with the facility. LPA was unable to interview additional residents due to language barriers. 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, Nov 15, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual linspection. LPA Urena arrived at the facility at 10:10 a.m. and was greeted by staff. The Administrator Zhanna Davtian arrived shortly thereafter. The purpose of the inspection was discussed with the administrator. At 10:45 a.m., LPA Urena and administrator conducted a tour of the inside and outside the facility to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility is a one-story dwelling located in the back of the property. KITCHEN: Knives are stored in a locked kitchen drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. The freezer and refrigerator are stocked with a variety of foods. Prepared foods were safely covered with lids. The hot water temperature measured at 112.1 degrees Fahrenheit. BEDROOMS: Bedrooms were furnished appropriately with appropriate furnishings, bed linens, and sufficient lighting. The facility has three bedrooms, which have double occupancy. BATHROOMS: There are two bathrooms. There is 1 bathroom in the hallway, and 1 bathroom in bedroom #3. The bathrooms were clean, the shower area was in clean condition with grab bars and a non-skid mat available. Paper towels were available for drying hands. Hand washing sign was displayed, and sufficient amounts of soap and paper products in each restroom. Hot water in residents’ bathrooms measured at 111.1 degrees Fahrenheit during today’s visit. Continues on LIC 809C... COMMON AREAS: The walls and flooring were checked for cleanliness and were observed to be in good condition. Furniture was observed to be clean, appropriate, and in good condition. Fire extinguisher was observed to be serviced within the last year. The facility maintained a comfortable temperature of 73 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers was fully charged and were last serviced 02/20223. The LPA observed required postings throughout the common space. GARAGE/OUTDOOR SPACE: The garage is connected to the house. The door to the garage was locked at the time of the inspection. An adequate supply of emergency food and water supply for six residents and two staff was observed. Diapers, and Personal Protection Equipment (PPE) is adequate, and the facility is able to obtain additional supplies as needed. Medications were observed to be locked away in the office/garage area and were inaccessible to residents. The backyard has a shaded outdoor area equipped with outdoor furniture in good repair for residents’ use. There were no bodies of water noted. RECORDS: Records review began at 12:15 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 12:50 p.m.; medications are centrally stored and locked in a file cabinet in the garage/office 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; Liability Insurance No deficiencies were cited at this time. Exit interview was conducted, a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 3, 2023