Eternal Life Senior Care Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. At 09:57 a.m., the LPA met with staff and explained the reason for the visit. Staff contacted Viktorya Hayrapetyan who stated that they would arrive within 30 minutes. The LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:51 a.m., hot water measured at 105.8-degree Fahrenheit. Laundry units, cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside the staff/ storage room. Emergency water was also located in the staff/ storage room. First aid kit was observed in the kitchen. Medications are located in a locked kitchen cabinet. COMMON AREAS: The LPA observed common areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last purchased on 03/28/2024. At 12:00 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Facility telephone was observed during the time of the visit. Flashlights and night lights were observed throughout the facility. Continued on LIC 809-C... BEDROOMS: The facility is a single-story residential home with four (4) bedrooms for residents’ use. The 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. Hot water measured at 105.8-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: The back patio has a covered outdoor area for resident use. Passageways were free and clear from obstruction. There are no bodies of water on the premises. There is a gate at the front of the facility designated for an emergency exit. RECORDS: 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 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. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability of Insurance _ Emergency Drill Logs No citations were issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 10, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. At 10:57 a.m., the LPA met with staff and explained the reason for the visit. Staff Viktorya Hayrapetyan arrived at the facility shortly thereafter. The Administrator was not available during the time of the visit and authorized staff Viktorya Hayrapetyan to sign the report. At 11:15 a.m., the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:51 a.m., hot water measured at 105.2-degree Fahrenheit. Laundry units, cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside the staff/ storage room. Emergency water was also located in the staff/ storage room. First aid kit was observed in the kitchen. Medications are located in a locked kitchen cabinet. COMMON AREAS: The LPA observed common areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last purchased on 03/28/2024. At 12:00 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Facility telephone was observed during the time of the visit. Flashlights and night lights were observed throughout the facility. Continued on LIC 809-C... BEDROOMS: The facility is a single-story residential home with four (4) bedrooms for resident use. The 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. Hot water measured at 108.0-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. OUTDOOR SPACE: The back patio has a covered outdoor area for resident use. Passageways were free and clear from obstruction. There are no bodies of water on the premises. There is a gate at the front of the facility designated for an emergency exit. RECORDS: 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 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. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability of Insurance _ Emergency Drill Logs No citations were issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 20, 2025

Allegation investigated: Staff overmedicated resident. Staff did not ensure facility phone was answered.

This is an amended report to reflect the finding for the second allegation that was inadvertently left out on LIC9099 C. Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a subsequent visit to deliver findings for the allegations listed above. The LPA was greeted by staff and informed them of the reason for the visit. Facility representative Viktorya Hayrapetyan was unable to come to the facility. LPA Urena read the report to the administrator and allowed facility representative to sign the report. On 07/03/204, Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct an initial 10-day visit to investigate the allegations listed above. LPA Urena interviewed staff, resident and administrator at approximately 9:45 a.m. and 11:57 a.m. and collected records pertinent to the allegation. LPA interviewed the resident's responsible party at 1:30 p.m. Continues on LIC9099C... Unsubstantiated Report is amended to include closing paragraph with findings for second allegation below. Staff over medicated resident.On the allegation that the ‘Staff over medicated resident’, it is the concern of the complainant that R1 was receiving unnecessary medications and that R1 appeared drugged, barely able to speak or eat as R1 appeared to be unable to hold bread or utensils, is unable to fully open their eyes, and is speaking gibberish. To investigate the allegation, the LPA reviewed the Centrally Stored Medication and Destruction Record (LIC 622) and compared against the list of medications ordered by R1’s physician. All medications listed in the LIC 622 and the physician’s orders matched. Additionally, the LPA conducted a medication audit of the medications (the quantity of pills) which matched the count as of the start date of assisting with the medications, and as listed in the LIC 622. The interview with R1’s responsible party (RP) revealed that the medications were prescribed by R1’s primary physician. The RP added that the physician was made aware of the reaction to a specific medication, and the physician removed the medication that may have caused the drowsiness. The LPA spoke with one of R1’s family members on 07/08/2024, and the family member stated that R1 was back to their normal self and no longer appeared confused or drugged. Based on the information gathered through interviews and record review, the allegation of Staff over medicated resident, is deemed Unsubstantiated at this time. Staff did not ensure facility phone was answered.On the allegation that ‘Staff did not ensure facility phone was answered’, it is the concern of the complainant that they attempted to reach staff at the facility, and tried three different times but was unable to get through. Complainant was hung up on during one of the calls. To investigate the allegation, LPA Urena interviewed staff(S1), regarding the facility staff not answering the phone, S1 stated that the phone is always answered. When the LPA asked why anyone would say that the phone was not answered, the S1 stated that often times the staff are busy caring for residents, changing the residents’ diapers, etc. and staff may not be able to answer the phone. The LPA called the phone number registered for the facility to test and see if the phone ring tone was loud enough to be heard by staff. The phone worked fine, and staff answered. The LPA interviewed the R1’s RP about the facility phone, and the RP stated that R1 cannot hold the phone or speak coherently, and they have never had a problem communicating with the facility and stated, ‘I am here with R1 at the facility almost every day, since R1 was admitted to the facility; I am happy with the care the caregivers are providing to R1’. Based on the information gathered through interviews and record review, the allegation of Staff did not ensure facility phone was answered’, is deemed Unsubstantiated at this time. LPA Urena emailed LIC9099 C to licensee to sign and return. Exit interview was conducted, and a copy of the report was issued.the state’s words, verbatim · CDSS document, Jul 9, 2024 · control 29-AS-20240702091428

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:57 a.m., the LPA met with staff and explained the reason for the visit. At 11:15 a.m., staff Viktorya Hayrapetyan arrived at the facility. The Administrator was not available during the time of the visit and authorized staff Viktorya H. to sign the report. At 11:50 a.m., the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen and dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:51 a.m., hot water measured at 105.2-degree Fahrenheit. Laundry units, cleaning solutions, chemicals and hazardous items were inaccessible and locked away inside the staff/ storage room. Emergency water was also located in the staff/ storage room. First aid kit was observed in the kitchen. Medications are located in a locked kitchen cabinet. OUTDOOR SPACE: At 11:53 a.m., the LPA observed the back patio which has a covered outdoor area for resident use. Passageways were free and clear from obstruction. There are no bodies of water on the premises. There is a gate at the front of the facility designated for an emergency exit. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, four (4) for resident use and one (1) for staff use and three (3) bathrooms. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. At 11:54 a.m., the LPA observed inoperable auditory devices in all resident room doors leading to the outside. Upon observation, staff stated that the auditory devices will be replaced with operable ones or fixed. Continued on LIC-809-C. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Starting 11:55 a.m., hot water measured at 108.0-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. COMMON AREAS: The LPA observed common areas to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last purchased on 03/28/2024. At 12:00 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Facility telephone was observed during the time of the visit. Flashlights and night lights were observed throughout the facility. During the time of the visit, the LPA obtained copies of the following: Emergency Disaster Plan, Infection Control Plan, LIC 308, and LIC 500. The Administrator’s certificate is active and expires on 09/01/2024. Due to time constraints, the LPA will return to complete the annual at a later date. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiency was cited (refer to LIC 809-D). Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 28, 2024