Just Like Home II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived unannounced to conduct a required annual visit. The LPA was greeted by staff. Introductions conducted and reason for visit was stated. Staff contacted the facility representative Alexsandra Vartapetova who arrived shortly thereafter. At approximately 12:30pm, LPA and the administrator conducted a tour of the inside, and outside of the facility to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. Smoke and Carbon monoxide detector observed operable during todays visit. COMMON AREAS: The living room and dining room 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. Room temperature was recorded at 78 degrees Fahrenheit. Required postings observed on the main entrance hallway wall. BEDROOM: The facility has six bedrooms with single occupancy, each bedroom has a private bathroom. Bedrooms were furnished appropriately with appropriate furnishings, bed linens, and sufficient lighting. Full rail observed on resident #5 Resident #5 is not on hospice at this time. BATHROOMS: Each of the six (6) bathrooms were observed to be clean; shower area was in clean condition with grab bars and a non-skid mat available. Towels for each resident were available for drying hands. Sufficient amount of hand soap, and paper products observed in each restroom. There were enough linens and towels for all residents. KITCHEN: The appliances were observed to be in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Supply of emergency food observed in the pantry which is good for current residents and staff. Fire extinguisher observed in the kitchen (10/2025). Kitchen knives were stored inaccessible to residents in care. (Continue to LIC809C) The facility has a guest bathroom in the hallway. Water temperatures in all bathrooms were recorded at temperatures within the regulations. OUTDOOR AREA/GARAGE: Backyard has a shaded outdoor area equipped with outdoor furniture in good repair for residents’ use. There were no bodies of water noted. Passageways were free of obstruction. LPA observed Personal Protection Equipment (PPE) supply observed adequate, and the facility is able to obtain additional supplies as needed. The supplies are found in the garage which is attached to the house. Door to the garage is kept locked and inaccessible to residents in care. RECORDS: At approximately 1p.m., staff records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Required staff training not met. Administrator stated that she will ensure staff are appropriately trained and all required training records are kept on file and available for review. At approximately 2p.m., residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. MEDICATIONS: At approximately 4p.m., medications were reviewed; medications are centrally stored and locked in a closet located in the hallway and inaccessible to residents; medications are labeled and checked for expiration dates. two out six resident centrally stored medications and destruction record reviewed. During the medication audit it was observed that residents medications are set for 7-days in advance by licensee. LPA requested copy of the following documents: updated LIC500 Personnel Report and liability insurance certificate be emailed for the office facility file. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived unannounced to conduct a required annual visit. The LPA was greeted by staff. Introductions conducted and reason for visit was stated. Staff contacted the facility representative Alexsandra Vartapetova who arrived shortly thereafter. At approximately 10:30am, LPA and the administrator conducted a tour of the inside, and outside of the facility to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. Smoke and Carbon monoxide detector observed operable during todays visit. COMMON AREAS: The living room and dining room 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. Room temperature was recorded at 76 degrees Fahrenheit. Required postings observed on the main entrance hallway wall. KITCHEN: The appliances were observed to be in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Supply of emergency food observed in the pantry which is good for current residents and staff. Fire extinguisher observed in the kitchen (purchased 12/03/2024). Kitchen knives were stored inaccessible to residents in care. Cleaning supplies observed under kitchen sink (windex and comet/ajax). Administrator removed the cleaning supplies to locked cabinet during visit. BEDROOM: The facility has six bedrooms with single occupancy, each bedroom has a private bathroom. Bedrooms were furnished appropriately with appropriate furnishings, bed linens, and sufficient lighting. There were enough linens and towels for all residents. BATHROOMS: Each of the six (6) bathrooms were observed to be clean; shower area was in clean condition with grab bars and a non-skid mat available. Towels for each resident were available for drying hands. Sufficient amount of hand soap, and paper products observed in each restroom. (Continue to LIC809C) The facility has a guest bathroom in the hallway. Water temperatures in all bathrooms were recorded at temperatures within the regulations. OUTDOOR AREA/GARAGE: Backyard has a shaded outdoor area equipped with outdoor furniture in good repair for residents’ use. There were no bodies of water noted. Passageways were free of obstruction. LPA observed Personal Protection Equipment (PPE) supply observed adequate, and the facility is able to obtain additional supplies as needed. The supplies are found in the garage which is attached to the house. Door to the garage is kept locked and inaccessible to residents in care. RECORDS: At approximately 11:30a.m., residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Four (4) out of five residents require an updated medical assessment and an annual needs and services plan/reappraisal. Hospice files not maintained at facility for resident #3 and resident #4. At approximately 1p.m., staff records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Required staff training not met. Administrator stated that she will ensure staff are appropriately trained and all required training records are kept on file and available for review. MEDICATIONS: At approximately 3p.m., medications were reviewed; medications are centrally stored and locked in a closet located in the hallway and inaccessible to residents; medications are labeled and checked for expiration dates. Five out five resident centrally stored medications and destruction record reviewed and observed incomplete and not accurate. Administrator stated that she will conduct an audit of all residents medication and ensure the records are up to date. Also PRN authorization letter was missing for resident #5. LPA requested copy of the following documents: updated LIC500 Personnel Report and liability insurance certificate. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 3, 2024

The state marks this report as 13 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived unannounced to conduct a required annual visit. The LPA was greeted by staff, the LPA explained the reason for the visit. The facility representative Alexsandra Vartapetova arrived shortly thereafter. LPA Urena, and the administrator conducted a tour of the inside, and outside of the facility to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. COMMON AREAS: The living room and dining room 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. Room temperature was recorded at 74 degrees Fahrenheit. A linen closet was observed by the entrance hallway. There were enough linens and towels for all residents. The LPA observed required postings by the main entrance hallway. KITCHEN: The appliances were observed to be in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. An adequate supply of emergency food for six residents and two staff was available. Fire extinguisher was purchased on 08/25/2023. Kitchen knives were stored in the locked garage, and inaccessible to residents in care. The administrator was advised to fix the kitchen drawer to keep knives stored and locked within easy access to caregivers. Continues on LIC 809C... BEDROOM: The facility has six bedrooms with single occupancy, each bedroom has a private bathroom. Bedrooms were furnished appropriately with appropriate furnishings, bed linens, and sufficient lighting. BATHROOMS: Each of the six (6) bathrooms were observed to be clean; 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. The facility has a staff/visitor bathroom in the hallway. Water temperatures in all bathrooms were recorded at temperatures within the regulations. OUTDOOR AREA/GARAGE: Backyard has a shaded outdoor area equipped with outdoor furniture in good repair for residents’ use. There were no bodies of water noted. Passageways were free of obstruction. Garage: Diapers, and Personal Protection Equipment (PPE) is adequate, and the facility is able to obtain additional supplies as needed. The supplies are found in the garage which is attached to the house. Door to the garage is kept locked and inaccessible to residents in care. RECORDS: Records review was done between 1:15 p.m. and 2:40 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 3:05 p.m.; medications are centrally stored and locked in a closet located in the hallway and inaccessible to residents; medications are labeled and checked for expiration dates. Medications were not properly documented on the centrally stored medications and destruction record. The following errors were observed during the medication review. The Centrally Stored Medication and Destruction Record (LIC 622) was incorrectly filled out, and the medications Duloxetine and Amlodipine were missing from the LIC's 622 for two residents. Pursuant to Title 22 of the CA Code of Regulations, and the Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D). 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, and liability insurance certificate. Deficiencies were cited at this time. Exit interview conducted. A copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Dec 13, 2023