Hms Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Zhanna Davtian, Administrator. The reason for today's visit was explained. The facility is a single storey family home consisting of a living room, a dining room, a kitchen, 4 resident bedrooms, 3 full bathrooms and a attached garage. The bathroom located by the kitchen is designated for staff us. Previously located along the left side of the home and directly behind the garage was a fenced in swimming pool that has since been fenced off as part of the property for the ADU. The ADU has a separate address of 14648 Runnymede Street and is not part of the facility operations. The home is fire cleared for 5 NON-AMBULATORY and 1 bedridden resident. Bedroom #3 is designated for bedridden use. On today's visit, all 12 domains of the CARE Inspection tool was reviewed. Also reviewed were 6 resident and 7 staff files. A tour of the physical plant, inside and outside, was conducted and the following were observed: the living room and dining room were furnished with the appropriate furniture for 6 residents. The fireplace in the living room was covered with a fire screen. Bedroom #1 and Bedroom #3 were observed with 2 each of the following - hospital beds, chairs, night stands, lamps and a shared dresser and closet. continued on LIC809-C Page 2. Bedroom #2 and bedroom #4 were observed with 1 each of the following: hospital bed, chair, night stand, lamp, dresser and a closet. the beds were observed with a mattress pad, fitted sheet and a comforter. Flat sheets were not observed per resident preference. Extra bed linens, towels and blankets were observed in the walk in linen closet located in the hall way. the kitchen is equipped with a stove, refrigerator, dishwasher and 2 microwaves. Knives are stored in a locked wooden cash kept in a kitchen drawer. sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed maintained on the premises. The laundry room, located by the kitchen was observed with a washing machine and dryer. Cleaning supplies, detergents and chemicals are stored in a locked cabinet in the laundry room and in the outside shed. All 3 bathrooms are equipped with a shower stall, toilet, grab bars, toilet risers, shower chairs, slip resistant mats and a single sink except the bathroom in the back, between bedroom #2 and bedroom #3, was observed with 2 sinks. Water temperature tested in the back bathroom read 123.7 degrees Fahrenheit and the front bathroom read 119.7 degrees Fahrenheit.. The hardwired smoke detectors and the combination detectors were tested and all were operational. The only fire extinguisher located by the front door was purchased on 2/24/25. The auditory devices on all four outside exiting doors were tested and were operational. The first aid kit and first aid manual was reviewed and met requirements. Medications and facility files were observed in 2 locked metal filing cabinets. All staff have current first aid training. The facility has the required general liability insurance and surety bond. The required posting were observed The backyard was observed with a table, chairs and a umbrella for outside activity. The back gate was observed with no locks. Also observed in the backyard was a storage shed. Trash cans were on the curb for trash pick up. Dried leaves were observed in the back and front yard due to the strong winds, otherwise the outside areas are well maintained. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy was provided.the state’s words, verbatim · CDSS document, Dec 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit at 9:35 a.m. Upon arrival, LPA was greeted by staff and Administrator. LPA met with Administrator Zhanna Davtian and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The facility is a single-story family home consisting of a living room, a dining room, a kitchen, 4 resident bedrooms, 3 full bathrooms and an attached garage. The home is fire cleared for 5 NON-AMBULATORY and 1 bedridden resident. Bedroom #3 is designated for bedridden use. KITCHEN: The LPA toured the kitchen/food service area at 9:40 a.m. The hot water was measured at 117.6 degrees Fahrenheit at 9:44 a.m. The kitchen appeared clean and the appliances and fixtures functional. Refrigerated and frozen foods were stored at proper temperature. There was a sufficient amount of two (2) day perishable and seven (7) day non-perishable food. Food labels were inspected and checked for dates and expiration dates. Food had labels clearly marked with dates. Knives and sharps were observed locked in a drawer. Cleaning supplies were stored in a locked cabinet in the laundry room adjacent to the kitchen locked and inaccessible. There were no pesticides or poisons observed near any food areas. (PAGE 1) (Report Continued on LIC 809-C PAGE 2...) (PAGE 2)(Report Continued from LIC 809 PAGE 1...) COMMON AREAS: The LPA inspected the living room and dining room area. The common areas were observed to be properly furnished and clean at the time of the visit. Furniture was observed to be in good condition. Fireplace was observed to be adequately screened at the time of the visit. The facility maintained a comfortable temperature. At 11:03 a.m., the smoke detector(s) and carbon monoxide detectors were tested and operational. Fire extinguishers were observed fully charged and purchased on 09/09/2024. The LPA observed required postings throughout the common spaces. The facility has a working telephone on premises. Auditory alarms on all doors were functional at the time of the visit. Entry/exits were free of obstruction. There is a washer and dryer on the premises. The last emergency disaster drill took place on 10/1/2024 and are conducted quarterly. Activities were observed in the common areas. An adequate supply of emergency food and water was observed in a hallway closet adjacent to the living room. LPA observed a sufficient supply of extra linens in a hallway closet. LPA observed a First Aid Kit located in the common room. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. OUTDOORS: There is a locked shed in the backyard with extra supplies. LPA observed a sufficient supply of Personal Protectant Equipment (PPE). The backyard has a shaded area with furniture including a table and chairs for resident use. The LPA observed one gate that self-latches with a clear passageway in case of an emergency. There were no bodies of water noted at the time of the visit. BEDROOMS: There are two (2) shared and two (2) private resident bedrooms. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. (Report Continued on LIC 809C PAGE 3...) (PAGE 3)(Report Continued from LIC 809-C PAGE 2...) BATHROOMS: There are three (3) full bathrooms for resident use of which one (1) is designated as a private resident bathroom. Resident bathrooms were clean, sanitary and in operating condition with grab bars and non-slip surfaces. The hot water was measured from approx. 9:50 a.m. – 10:02 a.m. and measured between 117.6 - 118.7 degrees Fahrenheit all within the required range. RECORDS: Records review began at 10:05 a.m., six (6) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All files were in order at this time. Four (4) Personnel records including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. The LPA and staff reviewed P&I Money at 12:00 p.m. for (1) resident who has their cash resources safe guarded by the facility. Cash resources were found to be separate and intact and not commingled with facility funds or petty cash. MEDICATIONS: Medications review for six (6) residents began at approximately 12:08 p.m. Medications are centrally stored in a locked filing cabinet located in a hallway closet adjacent to room #3 and are inaccessible to residents in care. All medications including PRNs were labeled, stored, and locked inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. No medication errors observed at this time. INTERVIEWS: From 12:20 p.m. – 12:45 p.m. LPA interviewed two (2) staff, and two (2) residents during the inspection. Staff were knowledgeable in resident rights, different forms of abuse and reporting procedures. Residents expressed no concerns at the time of the visit. During today’s visit, the LPA obtained copies of the following: LIC 500 Personnel Report, LIC 9020 Resident Roster, Current liability insurance, and a Surety bond. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 12, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Zhanna Davtian, Administrator. The reason for today's visit was explained. The facility is a single storey family home consisting of a living room, a dining room, a kitchen, 4 resident bedrooms, 3 full bathrooms and a attached garage. Located along the left side of the home and directly behind the garage is a fenced in swimming pool. The home is fire cleared for 5 NON-AMBULATORY and 1 bedridden resident. Bedroom #3 is designated for bedridden use. The following were observed on today's visit: The living room has the appropriate sitting for 6 residents, a coffee table, a television and a side table. The fireplace has a wire screen. The sliding glass door is equipped with a auditory device (operational) The dining room has a table with seating for 6 residents. The sliding glass door is equipped with a auditory device(operational) The kitchen has a stove, 2 microwaves and a refrigerator. Sufficient perishable foods were observed in the refrigerator. Sharp knives are stored in a locked box and is kept in a kitchen drawer. Adjacent to the kitchen is the laundry room with a washer and dryer. Detergents and cleaning supplies are stored in a locked cupboard. The garage is accessed through the kitchen and is primarily used for storage of the 7 days of non-perishable foods, 24 gallons of water, facility files, centrally stored medications, and bathroom supplies. Bedroom #2 and #4 both contain a twin bed, a chair, a night stand, a lamp and a closet. No dressers were observed. Bedroom #1 and #3 both contain 2 twin bed, 2 chairs, 2 night stands, 2 lamps and 2 closets. No dressers were observed. a private bathroom is located between bedroom #2 and #3. It contains 2 sinks, a toilet, a shower with a chair. Grab bars and non-skid mat were observed. Water was tested and read 120 degrees Fahrenheit. LPA Yee recommended that the water temperature to be adjusted slightly to ensure that the water temperature does not go beyond 120 degrees Fahrenheit. the bathroom located adjacent to Bedroom #1 contains a shower with a chair, a toilet, grab bar, a non-skid mat and a sink. The water temperature was tested and read 117.1 degrees Fahrenheit. the bathroom located adjacent to bedroom #4 contains a shower, sink, toilet, non-skid mat but no grab bars. Water temperature was tested and read 106.4 degrees Fahrenheit. The hardwired smoke detectors and smoke/carbon monoxide combination detectors were tested and were operational. the only fire extinguisher purchased on 2/11/23 is located by the front door. Extra bed linens, towels, blankets, comforters and pillows were observed in the hallway closet. First Aid kit contained the required tweezer, scissors and a common thermometer. First aid manual was also observed. All staff have current first aid/CPR training. Per tour of the physical plant, the outside areas and the pool were semi-clean due to the tree trimmers just trimming all the trees and the facility has not had the time to sweep up. The pool is secured with a 5 food rod iron fence. Per Administrator,replacement chairs and table been ordered for the backyard for outside activities. Trash cans located in the front were tightly sealed. Per review of facility files, the Licensee is the payee for Resident #6 and does not maintain a Surety bond. Per review of facility files, the Licensee was not able to provide evidence of Liability insurance except to provide copy of a insurance quote. Per review of the quote, the quote is for the three facilities owned by the licensee. They all share the same limit of 1 million per incident for a total annual aggregate of 3 million. Each facility needs to obtain liability insurance with the required limits. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted, APPEALS RIGHTS were discussed and a copy was provided.the state’s words, verbatim · CDSS document, Nov 30, 2023