Burbank Hills Comfort Living

Type of visit: Case Management - Annual Continuation

Licensing program analysts (LPAs) Jewel Baptiste and Noemi Galarza conducted an unannounced case management visit to reissue deficiencies and technical violations cited on 3/8/2022. LPAs was greeted by administer Narine Hannesyan and explain the reason for the visit. Upon arrival LPAs observed broken door bell. During todays visit LPAs toured the inside and outside of the facility.LPAs observed cleaning supplies unlocked and located in the hall closet. LPAs asked administrator about physicians orders for residents, to which she stated she is still working on it. LPAs also asked for in service training for staff, and administrator stated she trained staff but she did not keep record of the training. LPAs observed the garage is under construction and is being converted into Additional dwelling unit (ADU). Pool with required fencing was observed. The back yard is currently off limits to residents at this time. A change of operation and facility sketch will be submitted to Licensing with the updated information. During file review on 3/8/2022 LPA observed administrator certificate expired 3/31/2021, LPA checked CDSS online database and could not find the Administrator information (active/pending). On 3/11/22 LPA contacted admincertinfo@dss.ca.gov and they stated that they have not received anything from the administrator and the absence from the active/pending list is aligned with not having received a renewal application from the administrator for the 2021-2023 year. A technical violation was given on 3/8/22, LPAs will reissue citation with a type B violation. Report continued on 809c On 3/8/22 Staff#3 did not have criminal record clearance and was not associated to the facility. Per administrator Staff 3 has been living at the facility for three days. Staff left the facility during the visit. As of 3/17/22 S3 has been associated to the facility LPA issued type A violation and did not assess civil penalties at the time of the visit. LPA will reissue citation with civil penalties. During visit on 3/8/22 LPA Baptiste observed that all facility employee’s CPR card was expired. LPA issued a technical violation. LPA will reissue as a type B citation. On todays visit administrator showed proof of having CPR certification. During client file review on 3/8/22 LPA Baptiste observed Resident #1 file was missing pre-appraisal, needs and service and functionality capabilities form. Resident #2 physician report was blank, pre-appraisal, needs and service, and capability and functional form was missing. A technical violation was given on 3/8/22 and LPAs will reissue to type B citations. During medication review for residents#1 and #2 there was no physicians’ orders. LPA could not review medications. When LPA asked administrator how they administer medications to residents, she stated “we just read the bottle”. During today's visit, administrator has not obtained residents physicians orders. LPA will issue a type A citation. On 3/8/22, LPA Baptiste was informed by administrator Hannenesyan that the garage is being converted to a bedroom. LPA asked for a building permit and for Licensee to submit change of operation documents by 3/11/22. Administrator did not submit and or return phone calls. Due to technical problems on 3/8/22 LPA could not finish report to add information about garage. LPA was able to obtain a copy of the permit from city planning but has not received change of operation documents from Licensee. LPA will issue a type B citation. Pursuant to Title 22 code of regulations, the following deficiencies were cited (refer to LIC 809-D): Exit Interview Conducted with administrator / Appeal Rights Discussed / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Mar 17, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(e) · Plan of correction due date: Mar 18, 2022

Incidential Medical & Dental Care: For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all the following information This requirement is not met by evidence of: Based on record review, the licensee did not comply with the section cited above in 2 out of 3 residents did not have physicians’ orders in resident files, which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Administrator will ensure each resident has a copy of their completed physicians’ orders. Administrator understands that it is their responsibility to make sure each resident has physicians’ orders with their medications. Submit a copy of residents (R1-R3) physician orders by 3/18/22.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(1) · Plan of correction due date: Mar 18, 2022

87355 Crimanal Record Clearance(e) All individuals subject to a criminal record review pursant to Health and safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the department or This requirement is not met by evidence by: Based on record review on 3/8/2022, the licensee did not comply with the section cited above in 1 out of 1 Staff is not fingerprinted, associated or have background check clearance, which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: On 3/8/2022, staff (S3) immediately left the facility.Administrator acknowledged understanding that staff shall not return to work until criminal record clearance and association is complete. associated to the facility before S3 returns. Staff (S3) was cleared and associated to the facility on 3/10/22

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(d) · Plan of correction due date: Mar 24, 2022

87412 Personnel Records: The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: The licensee shall maintain documentation that an administrator has met the certification requirements specified in Section 87406, Administrator Certification Requirements or the recertification requirements in Section 87407, Administrator Recertification Requirements. This requirement is not met by evidence by: Based on record review, the licensee did not comply with the section cited above in 1 out of 1 staff Administrator Certification expired 3/31/21.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Administrator will submit the required document to Sacramento and pay the necessary fees to renew certification. A copy of new administrator certification is due to licensing by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Mar 30, 2022

87458 Medical Assessment:Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met by evidence by: Based on record review, the licensee did not comply with the section cited above in 2 out of 3 residents physicians report was blank and not update, which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Administrator will ensure residents files will be updated with a completed physician’s report signed by the doctor. Submit a copy of residents (R1-R3) physicians report by POC date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c)(1)(A) · Plan of correction due date: Mar 24, 2022

Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. The appraisal shall include, at a minimum, an evaluation of the 87457 Pre admission Appraisal- General: prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462 Social Factors. The licensee shall be permitted to use the form LIC 603 (Rev. 6/87), Preplacement Appraisal Information, to document the appraisal. This requirement is not met by evidence by: Based on record review, the licensee did not comply with the section cited above in 3 out of 3 residents did not have preplacement appraisal and functional capacities in resident files, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Administrator will ensure residents files will be updated with a completed pre appraisal and functional capabilities assessment in every residents file. Documents to be updated by 3/24/22. Submit a copy of residents (R1-R3) pre admission apprisal and functional capabilities assessment by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87208(a) · Plan of correction due date: Mar 24, 2022

87208- Plan of Operation:Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: This requirement is not met by evidence by: Administrator will ensure to submit a change of operation to CCLD and review regulation 87208(a) to ensure compliance in the future.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Based on observed, the licensee did not comply with the section cited above in Licensee did not inform CCLD and submitted a change of operation, which poses an immediate health, safety, or personal rights risk to persons in care. Administrator will update and submit a copy of facility sketch and change of operations by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Mar 24, 2022

87412 Personnel Records:The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: This requirement is not met by evidence by: Based- on record review, the licensee did not comply with the section cited above in 2 out of 2 Staff employee rights was not in their files, which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Administrator will ensure each Staff record will have a copy of their employee rights by 3/24/22. Administartor will update staff file and submit a copy to Licensing by POC.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87707(a)(2)(A) · Plan of correction due date: Mar 24, 2022

87707 Training Requirments: Direct care staff shall complete at least eight hours of in-service training about serving residents with dementia within 12 months of working in the facility and in each succeeding 12-month period. Direct care staff hired as of July 3, 2004 shall complete the eight hours of in-service training within 12 months of that date and in each succeeding 12-month period. A minimum of two of the following training topics shall be covered annually, and all topics shall be covered within a three-year period… This requirement is not met by evidence by: During record review on 3/8/22 and todays visit LPAs observe no staff training.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Administrator will make sure to keep record of all staff training. Submit a copy of staff in service training by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705 · Plan of correction due date: Mar 17, 2022

The following shall be stored inaccessible to residents with dementia:Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met by evidence by: During LPAs tour facility staff had left cleaning supplies in hall closet.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Administrator will ensure disinfectants and cleaning supplies are locked at all times. Administrator removed disinfectants and cleaning supplies during the visit. Corrected during the visit

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jewel Baptiste conducted an annual inspection visit at the facility with focus on the infection control domain, food, and medication review. LPA Baptiste met with Narine Hannesyan administrator and explained the reason for the visit. Upon arrival LPA observed administrator and staff#3 with out mask or face covering. Staff#3 is observed not associated and living at the facility. Facility is licensed to serve 6 over the age of 60 years old, which 6 non- ambulatory, of which 1 maybe bedridden. Facility has a hospice wavier for 3. At the time of inspection facility census is 5. Facility is located in a residential neighborhood, single story house, living room/ dining room, kitchen, 4 bedroom, 1 staff bedroom, and 2 bathrooms one of which is located in bedroom #2. LPA conducted file review of administrator and staff #1. During the review LPA observed administrator certificate expired 3/31/2021 and CPR card expired 9/2020. Staff #1 was missing employee rights. LPA conducted file and medication review for resident #1, #2 and #3. Resident #1 file was missing pre-appraisal, needs and service and functionality form. Resident #2 physician report was blank, pre-appraisal and needs and service, and capability and functional form was missing. Resident #3 did not have physicians’ orders for medications. Resident #3 file was missing, pre-appraisal, needs and service, and capability and functional form was missing. continued on 809c LPA and administer conducted tour of the facility together and observed the following: Kitchen area has sufficient food worth 2 days of perishables and 7 days of non-perishables. All bed rooms has sufficient lighting, furniture, and all the required bedding Bathrooms were observed with skid mats built into shower and grab bars. Water temperature was tested between 106.4- 106.5 degrees F, which is within the required 105-120 degrees F. LPA observed COVID-19 signs posted through out the facility, bathrooms observed with soap, signs and paper towels. Screening conducted for residents, staff and visitors. LPA observed PPE supplies for at least 30 days. Per administrator N95 fit testing was conducted for all staff. LPA observed fire extingusher is fully charged and dual units with carbon monixide detectors built in, they were tested and in working order. There were deficiencies found during today’s inspection. Deficiencies are cited from California Code of regulations, Title 22 and/or H&S Code 1569() and citations are listed on the attached LIC809D. If the deficiencies are not corrected by the noted due date, civil penalties may be assessed. Exit interview conducted, appeal rights provided, and copy of report left at the facility.the state’s words, verbatim · CDSS document, Mar 8, 2022

The state marks this report as 21 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 2 Year

Licensing Program Analyst (LPA) Danyle Wolter arrived at the facility unannounced to conduct a Required 2 Year inspection. Upon LPAs arrival, S2 and S3 were present and contacted administrator, Narine Hannesyan (certificate # 6034425740 exp 3/31/19), who arrived at 9:15am. Facility has a hospice waiver for three (3) and currently has one (1) resident on hospice. LPA conducted a file review at 9:20 am of two (2) staff records. S2 has criminal background clearance but is not associated to the facility, S3 has no criminal background clearance and is not associated to the facility. S1 and S2 do not have current First Aid training (exp 3/31/2017), staff has not completed twenty (20) hours of training in 2018. LPA reviewed five (5) residents files and found the files to be incomplete. R1 and R5 do not have physician reports, R1, R2, and R5 do not have Pre-Admission Appraisals, and R3 and R4 do not have reappraisals which have been completed in the last 12 months. LPA and administrator toured the facility together at 9:50am, including but not limited to: common living spaces, resident bedrooms; bathrooms, staff room/office, kitchen, and backyard. Facility has a garage in the backyard that was locked and administrator did not have a key to open it for inspection. Residents bedrooms and bathrooms were clean and in good repair, water temperature measured at 105.6 degrees F in resident bathroom. LPA observed adequate supply of extra towels and linens. Food supply for 2-day perishable and 7-day non-perishable was adequate. There is a pool in the backyard, pool is surrounded by a gate and is locked and inaccessible to residents. LPA observed fire extinguisher is fully charged and was purchased 10/28/18. LPA observed smoke detectors are present throughout the facility and are dual units with carbon monoxide detectors built in, they were tested and in working order. Report continued on LIC 809C LPA conducted a medication review at 10:15am and observed medications for R4 to be pre-poured for seven (7) days in a morning/afternoon/evening 7-day pill container. R4 also had multiple PRN medications and Vitamins which did not have physician orders, R4s 602 states they cannot determine their own needs for PRN medications. R4s prescription medications were unavailable as administrator stated they are stored in the locked garage. R3 had medications pre-poured in a 7-day pill container, R3 has physician orders but no medications were observed besides the medications which were prepoured and administrator told LPA that R3 takes no medications, administrator could not produce discontinue orders for medications. The following deficiencies were observed during today's inspection: S2 is working in the facility and is not associated. S3 was present in the in the facility and does not have criminal background clearance. S1 and S2 do not have current First Aid Training. Staff training has not been completed in 2018. Garage was locked and unavailable to be toured. R3 and R4 have medications pre-poured for 7 days. R3 has no discontinue order for medications with physician orders, medications were not observed on hand. Facility staff is not adequate in numbers R4 has PRN medications and Vitamins which do not have physician orders. R1 and R5 do not have physician reports in their files. R1, R2, and R5 do not have Pre-Admission Appraisals in their files. R3 and R4 have appraisals which have not been updated in the last 12 months. There were deficiencies found during today’s inspection. Deficiencies are cited from California Code of regulations, Title 22 and/or H&S Code 1569() and citations are listed on the attached LIC809D. If the deficiencies are not corrected by the noted due date, civil penalties may be assessed. Civil penalties were assessed during today's visit. S2 and S3 left facility during LPAs inspection, Administrator understands they are not to return until they have proper criminal background clearance and/or are associated to the facility. Exit interview conducted, appeal rights provided, and copy of report left at the facility.the state’s words, verbatim · CDSS document, Dec 14, 2018

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Dec 15, 2018

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: when LPA arrived S3 was present at the facility and interacting with residents, S3 does not have criminal record clearance. Administrator told LPA that S3 has been volunteering in the facility for about a month and that she wanted to see how she did before she hired her. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to obtain criminal record clearance for S3 and ensure S3 is associated to the facility before S3 returns. Administrator understands that S3 is not allowed in the facility until this is completed. Furthermore, administrator understands that it is her responsibility to ensure that S3 has criminal record clearance and is associated before returning. **Immediate civil penalties assessed** Proof of correction due to CCL by plan of correction date of 12/15/18. Danyle.Wolter@dss.ca.gov

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: Dec 15, 2018

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: upon LPAs arrival, LPA observed S2 to be present at the facility. LPA reviewed S2's file and did not observe a LIC 9182 for criminal record clearance transfer request to the facility. Administrator was unable to provide proof of transfer request. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to complete LIC 9182 for S2 and turn it in to the Regional Office at Monterey Park. Administrator understands that S2 is not to be present in the facility until they are associated. Furthermore, administrator understands and agrees that it is their responsibility to ensure that the transfer request is complete before S2 returns to work. Proof of correction due to CCL by 12/15/18. **Immediate civil penalties assessed.** Danyle.Wolter@dss.ca.gov

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87755(a) · Plan of correction due date: Dec 15, 2018

87755 Inspection Authority of the Licensing Agency (a) Any duly authorized officer, employee or agent of the licensing agency may, upon proper identification and upon stating the purpose of his/her visit, enter and inspect the entire premise of any place providing services at any time, with or without advance notice. This requirement is not met as evidenced by: during LPAs tour of facility with administrator, LPA could not inspect garage outside because it was locked and administrator did not have a key. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to review regulation 87755 and write a letter of understanding. Additionally, administrator agrees to ensure that a key is always at the facility to ensure garage is accessible. Proof of correction due to CCL by 12/15/18. Danyle.Wolter@dss.ca.gov **Immediate civil penalties assessed**

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(e) · Plan of correction due date: Dec 15, 2018

87465 Incidental Medical and Dental Care (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement is not met as evidenced by: during LPAs medication review, LPA observed R4 to have PRNs and Vitamins which did not have physician orders. LPA reviewed R4s 602 and R4 is unable to administer own PRN medications. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to obtain physician orders for PRN medications or cease use. Additionally, administrator agrees to review regulation 87465 and write a letter of understanding. Proof of correction due to CCL by 12/15/18. Danyle.Wolter@dss.ca.gov

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(5) · Plan of correction due date: Dec 15, 2018

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: during LPAs medication review, LPA observed R3 and R4 to have medications which were prepoured for 7 days in a morning/afternoon/evening in a 7-day pill container. Administrator was unable to show LPA original containers as they were stored in the garage and the garage was locked and unable to be accessed. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to ensure that medication stays in its originally received container, administrator understands that medication cannot be prepoured. Administrator agrees to review regulation 87465 and send a letter of understanding to CCL by 12/15/18. Danyle.Wolter@dss.ca.gov **LPA provided administrator with link for medication guide. http://ccld.ca.gov/res/pdf/MedicationsGuide.pdf

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(c)(2) · Plan of correction due date: Dec 15, 2018

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: during LPAs medication review, LPA observed R3 to have medications prepoured in a 7-day pill container but no other medications on hand. Administrator told LPA that R3 does not take medications but could not provide discontinue orders for the prescribed medications on R3's LIC 602. R3's medications are not being given per physician orders. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to obtain discontinue orders for R3s medication from physician. If physician states R3 still needs medications then administrator is to refill prescriptions. Proof of correction due to CCL by 12/15/18. Danyle.Wolter@dss.ca.gov

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(c)(1) · Plan of correction due date: Dec 15, 2018

87411 Personnel Requirements - General(c) All RCFE staff who assist residents with personal activities of daily living shall receive at least ten hours of initial training within the first four weeks of employment and at least four hours annually thereafter. (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: during LPAs file review, LPA observed no staff to have current 1st Aid Training. This poses an immediate health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to obtain First Aid Training for themself and ensure that staff have First Aid Training as well. Proof of scheduled first aid training due to CCL by 12/15/18. Danyle.Wolter@dss.ca.gov

From the deficiency page — Deficiency type: Type A · Section cited: CCR87411(a) · Plan of correction due date: Dec 15, 2018

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. [...] This requirement is not met as evidenced by: during LPAs inspection, LPA observed only administrator was able to assist all residents and prepare food for lunch. During file review, LPA observed the administrator is the only person associated to the facility and able to work. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to ensure that facility staff is adequate in numbers to ensure that residents needs are met 24-hours a day. Proof of correction due to CCL by 12/15/18. Danyle.Wolter@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Jan 11, 2019

87457 Pre-Admission Appraisal - General (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: during LPAs file review, LPA observed R1, R2, and R5 did not have Pre-Admission Appraisals completed before moving in. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to ensure that Pre-Admission appraisals are completed before residents move in. Furthermore, administrator agrees to complete appraisals on R1, R2, and R5. Proof of correction due to CCL by 1/11/19. Danyle.Wolter@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Jan 11, 2019

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: during LPAs file review, LPA observed R1 and R5 do not have medical assessments in their files. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to schedule appointments for R1 and R5 to have medical assessments completed. Proof of correction due to CCL by 1/11/19. Danyle.Wolter@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(c) · Plan of correction due date: Jan 11, 2019

87463 Reappraisals (c) The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: during LPAs review of residents files, LPA observed R3 and R4 to have appraisals which have not been updated in the last 12 months as required. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to complete reappraisals for R3 and R4 by plan of corrections date of 1/11/19. Additionally, administrator agrees to create a calendar of when all residents reappraisals need to be completed.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(b)(1) · Plan of correction due date: Jan 11, 2019

§1569.625 Staff training; legislative findings; contents (b)(1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision This requirement is not met as evidenced by: during LPAs file review LPA observed the only staff training completed in 2018 was dementia training, the other topics had not been covered. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 14, 2018

Plan of correction: Administrator agrees to create a calendar for what training needs to be completed in 2019. Calendar will include what training will be done each month to ensure all training and topics are covered. Proof of correction due to CCL by 1/11/19. Danyle.Wolter@dss.ca.gov LPA printed out H&S Code 1569.625 in its entirety for administrator.

The state marks this report as 21 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Prelicensing

The prelicensing visit was conducted by LPA Aja Richardson The LPA met with applicant Narine Hannesyan. This is a new facility. The physical plant was toured inside and out. The facility has been cleared for 6 nonambulatory residents which one may be bedridden. The facility has two private resident bedrooms and two shared resident rooms. Rooms 3 and 4 have direct exits to the outside. Rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. Lighting in the rooms appeared adequate. The office is a designated staff room. There is one bathroom in the hallway and one bathroom in room number two. The resident bathrooms have a shower with non-skid materials. The toilet and showers have grab bars. The common areas were appropriately furnished and the lighting was adequate. Resident and staff records are stored in a filing cabinet which is currently located in the staff room. Medications are currently stored in a locked cabinet in the kitchen. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in kitchen cabinet. Kitchen knives are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. The supply of nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the kitchen. There is a fireplace in the living room. It is screened and there are no tools. The facility smoke alarms and carbon monoxide alarms were tested and working. There is one fire extinguisher in the home and it is charged. Hot water was tested in the resident bathroom; it measured 107.8 degrees Fahrenheit. The laundry area is located outside in the backyard in a storage shed. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) are stored in kitchen cabinet. Extra incontinency supplies are stored in hallway closet. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted in hallway. Emergency telephone numbers are posted in the hallway. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The entire property is fenced. The back and side of the house is separated from the front yard by a gate. There is a door w/gate with a self-latching mechanism for persons to enter the front yard. There is a locked storage shed in the back yard. There is a pool in the back yard that is surrounded by a locked fence. The garage is not accessible from the house; the doors were locked. The garage has been converted a staff room/storage. The following items are needed for the facility to comply with Title 22 Regulations. 1) Television in living room/dining area 2) Alarm on kitchen exit door 3) Washer and dryer Please provide proof that all the above listed items have been completed to your Centralized Applications Unit (CAU) Analyst with-in 10 working days. This report will be sent to the Centralized Application Unit (CAU). You will be notified by the CAU Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAU Analyst. Failure to comply could affect approval of your license. Exit interview held and report issued.the state’s words, verbatim · CDSS document, Dec 7, 2016

The state marks this report as 21 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

On November 02, 2016, Component II was held. The following individual participated: Narine Hannesyan, CEO of Burbank Hills Comfort Care INC and Administrator of Burbank Hills Comfort Living. When Narine Hannesyan was asked if she has read and understands Title 22, she responded in the affirmative. Component II was successfully completed.the state’s words, verbatim · CDSS document, Nov 2, 2016

The state marks this report as 21 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.