Laurel Canyon Residential Care

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a case management-deficiencies visit at 10:16 AM. LPA met with the facility Administrator Kristine Harutunyan and later the Assistant Administrator Mariam Harutunyan. Entrance interview conducted and the reason for the visit was explained. This report was generated to issue citations that were observed during a visit to the facility on 05/28/2026. During the visit on 05/28/2026 LPA observed an unsecured tube of medicated cream in the dining area of the facility. LPA notified the Assistant Administrator who secured the item at the time of the visit. LPA observed the caregiver bedroom to be unlocked and LPA observed an unsecured bottle of spray cleaner. LPA notified the Assistant Administrator who secured the item at the time of the visit. LPA observed unsecured automotive chemicals including oil and coolant. LPA notified the Assistant Administrator who secured the items at the time of the visit. LPA observed a fire extinguisher that was purchased on 02/20/2025 which was outside of the required yearly timeframe. LPA conducted a file review and observed one (1) resident medical assessment that was not signed by a licensed medical professional. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were 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, Jun 15, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jun 15, 2026

(a) ...cleaning solutions, ...tools, sharp objects, and other similar items... are in locked storage... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as automotive chemicals and cleaning solutions were left outside of secured storage which posed an immediate safety risk to clients in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: Administrator secured the items at the time of the visit. POC cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Jun 15, 2026

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place ... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as a medicated cream was left outside of locked storage which posed an immediate health risk to clients in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: Administrator secured the item at the time of the visit. POC cleared.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.149 · Plan of correction due date: Jun 15, 2026

§1569.149 Fire clearance approval... ...the facility shall secure and maintain a fire clearance approval from the local fire enforcing agency... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the facility's fire extinguishers were last purchased more than 12 months ago which posed an immediate safety risk to clients in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: The Administrator purchased a new fire extinguisher on 05/31/2026. POC cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Jun 29, 2026

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as one resident physician report was signed as completed by a placement agent and not a medical professional which posed a potential health risk to clients in care.the state’s words, verbatim · CDSS document, Jun 15, 2026

Plan of correction: Administrator agreed to submit a statement of understanding confirming that they will review future medical assessments for accuracy before accepting documents. Administrator agreed to submit the signed statement to CCLD no later than POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:16 AM. LPA met with the facility Administrator Kristine Harutunyan and later the Assistant Administrator Mariam Harutunyan. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:18 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: 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 fire extinguisher mounted on the wall to be purchased on 05/31/2026. The kitchen contained a locked under sink cabinet which contained chemicals and a secured drawer which contained knives and other sharp objects. LPA observed a locked cabinet that contained resident medications. LPA observed an unsecured daily pill organizer which contained medications. LPA notified the Administrator who immediately secured the medications. BEDROOMS: There are four (4) bedrooms in the facility; three (3) are dual occupancy resident rooms and one (1) is a staff room. LPA, and the facility Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. One (1) resident bed was observed to contain full bed rails. Bedrooms #3&4 contained direct exits to the outdoors of the facility. LPA observed the staff bedroom to be unlocked and LPA observed unsecured supplements. LPA notified the Administrator who immediately secured the staff bedroom. Continued on LIC 809C. COMMON AREAS: This included the living room, hallway, and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a television and adequate seating. The hallway was observed to contain two closets which contained care supplies and dry food storage. The dining area was observed to be equipped with adequate seating for resident use. All furniture throughout the facility was observed to be clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 11:21 AM and functioned properly at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. BATHROOMS: There are two (2) bathrooms at the facility. One (1) designated as a private resident bathroom, one (1) is designated as a staff bathroom. The resident bathroom was observed to be clean and was equipped with nonskid surfaces. Grab bars were observed in the resident shower and near the resident toilet, all were properly secured. The water temperature was measured to be between 112.8 and 118.9 degrees Fahrenheit, which is in compliance with regulation. LPA observed the resident bathroom to have secured under sink storage which contained cleaning chemicals. LPA observed an unsecured bottle of bleach in an unsecured cabinet in the resident bathroom. LPA notified the Administrator who immediately secured the item. LPA observed the staff bathroom to contain the facility’s washer and dryer. OUTDOOR SPACE: The facility has one (1) emergency exit gate located at the front of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed cameras located throughout the outdoor areas of the facility. RECORD REVIEW: Record review began at 11:24 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. Three (3) staff files were reviewed. LPA observed all three (3) staff files to be missing a completed Criminal Record Statement (LIC 508). LPA observed two (2) staff files to be missing a valid first aid/CPR card. LPA informed the Assistant Administrator and Administrator that staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. The Administrator agreed to contact the trainer who provided the training to obtain a valid First Aid/CPR card. LPA observed one (1) staff file to contain twenty (20) hours of initial training but the file was observed to be missing the additional twenty (20) hours of required training to be completed within the first four (4) weeks of employment. Continued on LIC 809C. RECORD REVIEW CONT.: Five (5) resident files were reviewed. LPA observed one (1) resident to be missing proof of a negative TB test. LPA informed the Assistant Administrator who agreed to obtain proof of a negative TB test for the resident. LPA observed one (1) resident admission agreement to be missing the amount charged for basic services. LPA informed the Assistant Administrator that admission agreements shall specify the rate for all basic services which the facility is required to provide. The assistant Administrator expressed understanding and agreed to revise the admission agreement with the resident and the resident’s responsible party. LPA observed one (1) resident’s bed to contain full bed rails. LPA observed that the resident was not enrolled in hospice care. LPA informed the Assistant Administrator that bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. The Assistant Administrator expressed understanding and agreed to remove the bed rails. MEDICATION REVIEW: Medication review began at approximately 01:00 PM. Medications for three (3) of five (5) residents were observed. All medications were stored properly. LPA observed two (2) medications that were not logged on their respective Centrally Stored Medication and Destruction Record Sheets (CSMDRs). LPA informed the Assistant Administrator who logged the medications at the time of the visit. 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. LPA observed the infection control plan to not be reviewed/updates annually. LPA informed the Assistant Administrator that the licensee shall review the use of infection control procedures in the facility at least annually. The Assistant Administrator agreed to conduct a review of the facility’s infection control plan. Emergency disaster drills are to be conducted quarterly. The facility’ was unable to provide LPA proof of the last completed disaster drill. The facility’s emergency disaster plan was not reviewed/updated annually and contained outdated information. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on their role and responsibilities, the resident’s rights, the different forms of abuse, and the appropriate reporting procedures for suspected abuse. Continued on LIC 809C. During today’s visit LPA obtained a copy of the facility’s emergency disaster plan, and current liability insurance. The facility was unable to provide LPA with an updated LIC 500 or resident roster. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were 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, Jun 15, 2026

The state marks this report as 15 pages; the online copy we transcribed has 12. You can request the full file from the county licensing office.

Allegation investigated: Staff did not notice residents change in condition Neglect/lack of supervision Staff did not notify residents authorized representative of hospitalization

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 01:13 PM. LPA met with facility staff who contacted the Administrator Kristine Harutyunyan. The Administrator arrived at 01:20 PM. Entrance interview was conducted and the reason for the visit was explained. On 12/05/2025 the Woodland Hills North Adult and Senior Care Regional Office (RO) received a complaint alleging that facility staff did not notice Resident #1’s (R1) change in condition, staff did not notify R1’s authorized representative of hospitalization, and Neglect/lack of supervision of R1. The complaint was investigated by the Department. CONTINUED ON LIC 9099C. Substantiated On 12/08/2025 LPA Sandra Urena initiated the investigation and conducted a physical plant tour, interviewed the Administrator, and collected copies of pertinent documentation. During the course of the investigation, the Department subpoenaed medical records, the EMS report, 911 call audio, call logs and other pertinent records for Staff #1 (S1). On 02/03/2026 an Investigator conducted a physical plant tour at the facility and conducted interviews with Resident #2 (R2). Additionally, interviews were conducted on 02/05/2026 with Witness #1 (W1), on 03/13/2026 with Witness #3 (W3), on 04/23/2026 with the Administrator, and on 05/01/2026 with Witness #4 (W4). Multiple attempts between 02/03/2026 and 04/01/2026 were made to interview R1, although R1 could not be located. During today’s visit LPA conducted a physical plant tour, collected copies of pertinent documentation, and conducted interviews with the Administrator and Assistant Administrator between 01:20 PM and 03:00 PM. The allegations of “Staff did not notice residents change in condition” and “Neglect/lack of supervision” allege that facility staff did not notice a change in condition of R1 which resulted in R1 being admitted to the hospital in critical condition and that facility staff failed to take appropriate timely actions to address a change in condition of R1. Interview with the Administrator revealed on 12/01/2025 they contacted 911 because R1 did not look/feel good. The Administrator stated that they first observed R1 feeling unwell on either Thursday, 11/27/2025, or Friday, 11/28/2025. The Administrator stated that they did not call 911 before because “R1 was not that bad,” but the Administrator got scared when they noticed R1’s low blood pressure. The Administrator stated that on 11/27/2025 or 11/28/2025 they noticed that R1 was “coughing with phlegm,” without any breathing problems. The Administrator stated that they gave R1 one (1) Medication #1 (M1) tablet for the phlegm on 11/27/2025 or 11/28/2025. The Administrator confirmed that M1 was prescribed to the Administrator and not R1. The Administrator stated that if they felt R1 was not doing well, they would have called 911. The Administrator stated that R1 was not feeling good for approximately 3-4 days before the Administrator called 911. The Administrator stated that they noticed that R1’s condition had changed completely on Sunday 11/30/2026. The Administrator stated that they were unable to recall how many total doses of M1 they administered to R1. The Administrator stated that they reviewed R1’s medical documentation and observed that R1 had a noted allergy to antibiotics and ceased administration of M1 after observing the documented allergy. The Administrator stated, “I know it's not right to give R1 the M1 without a prescription.” CONTINUED ON LIC 9099C. Record review revealed, upon EMS arrival on 12/01/2025, paramedics assessed R1 and determined R1 was bradycardic and hypotensive and transported to the hospital. At the hospital, R1 was diagnosed with multiple medical conditions that included Bradycardia, Thrombocytopenia, Hypothermia, Sepsis of an unspecified organism, Severe sepsis with septic shock, Respiratory failure, Pneumonia, Hyperosmolality, and Hypernatremia. Interview with W1 revealed that R1 had been admitted to the hospital in critical condition. W1 stated when R1 arrived they had no identifying information for R1 and W1 had to contact the fire department to obtain R1's information. W1 reported that the emergency room doctor informed W1, based on the condition R1 was admitted in, R1 had clearly been neglected for several days prior to admission to the hospital. W1 stated that R1 had a dangerously low temperature of 83 degrees Fahrenheit and was barely responsive. R1 was also on multiple life-saving medications and measures for an extended period. R1 was discharged to a skilled nursing facility after a month in the hospital. W1 stated R1 required a lot of help, would not be able to be independent, and would require a long-term feeding tube. Based on the information obtained during interviews and record review there is sufficient evidence to support the allegations of “Staff did not notice residents change in condition” and “Neglect/lack of supervision.” Therefore, the allegations are deemed Substantiated at this time. LPA informed the Administrator that an immediate civil penalty in the amount of $500 is being assessed on today’s date (05/28/2026) for a violation that resulted in the injury or illness of an individual in care. The Administrator was also informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). CONTINUED ON LIC 9099C. The allegation of “Staff did not notify residents authorized representative of hospitalization” alleges that facility staff did not notify R1’s authorized representative of the 12/01/2025 hospitalization of R1. LPA conducted a file review for R1 and observed Individual #1 (I1) to be listed as R1’s emergency contact. LPA interviewed the Administrator and asked if I1 was notified of R1’s hospitalization within the required timeframe. The Administrator stated that the facility Assistant Administrator attempted to notify I1 of R1’s hospitalization at the time of the incident but did not receive any response. LPA interviewed the Assistant Administrator who stated that they attempted to notify I1 of R1’s hospitalization multiple times via telephone call and text message around the time R1 was hospitalized. The Assistant Administrator provided LPA with proof of a message sent to I1 by the Assistant Administrator on 12/11/2025. LPA reviewed the facility file and observed an incident report that was submitted to Community Care Licensing Division (CCLD) on 12/16/2025. LPA informed the Administrator and Assistant Administrator that a written report shall be submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of an incident which threatens the health, safety, or wellbeing of the resident. The Administrator and Assistant Administrator were unable to provide proof that they had contacted I1 or CCLD within the required timeframe. Based on interviews and record review there is sufficient evidence to support the allegation of “Staff did not notify residents authorized representative of hospitalization.” Therefore, the allegation is deemed Substantiated at this time. The following deficiencies and civil penalty were cited/assessed (refer to LIC 9099Ds). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.the state’s words, verbatim · CDSS document, May 28, 2026 · control 29-AS-20251205112600

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: May 29, 2026

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as the facility did not provide appropriate timely care for R1's medical emergency which resulted in R1 being admitted to the hospital in critical condition which posed an immediate health concern to clients in care.the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: The Administrator agreed to conduct an in service training with all staff including the Administrator and Assistant Administrator about the importance of noticing the signs/symptoms of illness and seeking appropriate medical attention in a timely manner. The Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: May 29, 2026

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes....and that appropriate assistance is provided when such observation reveals unmet needs...This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as the facility did not seek timely medical attention for R1 which resulted in R1 being admitted to the hospital in critical condition which posed an immediate health concern to clients in care.the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: The Administrator agreed to conduct an in service training with all staff including the Administrator and Assistant Administrator about the importance of noticing the signs/symptoms of illness and seeking appropriate medical attention in a timely manner. The Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(1) · Plan of correction due date: May 29, 2026

87405 Administrator - Qualifications... (d) The administrator shall have the qualifications specified... (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not met as evidenced by: Based on interviews and record review the licensee did not comply with the section cited above as the Administrator administered M1 to R1 when M1 was not prescribed to R1 and R1 had a documented allergy to M1 which posed an immediate health concern to clients in care.the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: Administrator agreed to conduct four hours of medication administration training with all staff members that administer medications to residents including the Administrator and Assistant Administrator. Administrator agreed to submit proof of the completed training to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jun 11, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency... (1) A written report shall be submitted to the licensing agency and to the person responsible...within seven days... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as the facility did not have proof that R1's responsible party or the department were notified of R1's 12/01/2025 hospitalization within the required timeframe which posed a potential safety risk to clients in care.the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: Administrator agreed to submit a statement of understanding confirming that they are aware of the reporting requirements timeframe and that they will adhere to the required timeframe when submitting future incident reports to CCLD no later than POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 03:06 PM to conduct an unannounced Case Management – Deficiencies visit at the facility today. LPA met with facility Administrator Assistant Mariam Harutyunyan entrance interview conducted and the reason for the visit was explained. Administrator Kristine Harutyunyan later arrived to the facility and an entrance interview was conducted. During today’s visit between 03:10 PM and 04:23 PM LPA conducted a physical plant tour, interviewed Administrator, the Assistant Administrator, and one (1) Individual (I1). During the physical plant tour LPA observed bedroom #1’s ceiling to be in disrepair with visible water damage. LPA observed the ceiling to be missing a panel with insulation exposed. Additionally, LPA observed the room to smell of mildew. LPA reviewed the facility sketch and observed bedroom #1 to be designated as a staff bedroom. LPA interviewed the Assistant Administrator who informed LPA that residents had not resided in the room and staff had been relocated to bedroom #2 until repairs to bedroom #1 could be made. Assistant Administrator stated that the room has been made inaccessible to clients in care until repairs to the ceiling repair can be completed. Assistant Administrator stated that repairs are expected to be completed no later than 02/13/2026. LPA determined that the damage to the ceiling did not pose an immediate or potential health, safety, or personal rights risk to the clients in care. This is considered a technical violation and no citation is being issued at this time. Continued on LIC 809C. During interviews with the Assistant Administrator and during file review LPA observed that no incident report was submitted for the ceiling damage. Additionally, LPA observed the conversion of the facility’s garage into an ADU which was also not reported to Community Care Licensing Division (CCLD). LPA informed the Assistant Administrator that any incident which threatens the welfare, safety or health of any resident, or unexplained absence of any resident from the facility must be reported to CCLD within 7 days of the occurrence of the event. Additionally, LPA informed the Assistant Administrator that any construction or alterations to the facility should be reported to CCLD prior to beginning the proposed construction. Because no residents resided in bedroom #1 and because all proper building permits for the garage conversion appeared to be obtained LPA determined that the missing reports did not pose an immediate or potential health, safety, or personal rights risk to the clients in care. This is considered a technical violation and no citation is being issued at this time. LPA spoke with the Administrator, Assistant Administrator, and I1 and informed them that due to the garage conversion to an ADU, the former garage now has a separate address from the facility. LPA explained that the facility is required to submit an updated facility sketch which reflects that the garage is no longer part of the facility as a part of their plan of operation. The Assistant Administrator expressed understanding and agreed to submit an updated facility sketch to CCLD. Additionally, LPA informed the Administrator that the fire clearance for the facility states “Garage to remain a garage”. LPA explained that because proper permits were obtained for the conversion no fire clearance violation is being issued at this time. LPA explained that the facility may be required to obtain an updated fire clearance at a later time to reflect the construction changes and new address of the former garage. Pursuant to Title 22, California Code of Regulations, the following deficiency was cited (refer to LIC809-D). Exit interview conducted and copy of the report was issued and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 3, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(7) · Plan of correction due date: Feb 17, 2026

87208 Plan of Operation (a)…shall be submitted to the licensing agency for approval…shall contain...: (7) Sketches, showing dimensions, of the following: This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as the licensee did not submit an updated facility sketch to the department after the conversion of the facility's garage to an ADU which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Administrator agreed to submit an updated facility sketch to CCLD no later than POC due date.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility at 09:33 AM. The LPA met with applicant, Kristine Harutyunyan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested for six (6) residents. The facility is one story. At 09:35 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for six (6) bedridden residents. The facility has one (1) private staff bedroom, Room #1, and three (3) shared resident rooms, Rooms #2, 3, and 4. Bedrooms #3 and 4 have direct exits to the outside. The facility is equipped with a fire sprinkler system. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. Bedrooms #1 was observed to have a rip in the window screen and bedroom #2 was observed to be missing a window screen. There are two (2) bathrooms in the facility. Bathroom one (1) located next to the kitchen, is designated as a staff bathroom. The resident bathroom has a shower with non-skid materials. The toilet and shower have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Continued on LIC 809C. Resident and staff records are stored in the Administrator’s desk which is currently located in the living room. Medications are centrally stored in a locked cabinet in the kitchen. The first aid supplies are stored in the entryway and were complete, including a thermometer and a current version of a first aid manual. 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 dishes, utensils, pots, pans and drinkware is adequate. LPA was unable to measure the temperature of the refrigerator or the freezer due to the absence of a temperature gauges. The supply of nonperishable and perishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Kitchen, laundry and house cleaning supplies are stored in locked cabinets located under the kitchen and bathroom sinks. LPA observed the under-sink cabinet located in the staff bathroom to contain laundry chemicals and lack a locking device. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. LPA observed the front Stairway of the facility to lack a ramp for resident access which poses a potential hazard to residents with poor balance or eyesight. One (1) ramp, connected to bedrooms #3 and 4 was secure and non-slippery and was positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and were functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. The smoke detector, fire doors, and carbon monoxide detectors were tested at 10:07 AM and functioned properly during the time of visit. Continued on LIC 809C. There are two (2) fire extinguishers throughout the house. They are fully charged and do not exceed the expiration date. Hot water was tested in each bathroom, which included the resident bathroom and staff bathroom, in addition to the kitchen; and, the hot water ranged from 117.0 to 118.6 degrees Fahrenheit. The laundry area is located in the staff bathroom. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in a hallway closet in addition to incontinence supplies. There is a functioning telephone on the premises. LPA did not observe emergency exiting plans/sketch posted in the facility. LPA did not observe emergency telephone numbers posted in the facility. Other required postings are posted in the living room and dining area. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the front of the house with tables and chairs where residents can sit. The entire property is fenced. An additional home with a separate address is separated from the facility by a fence and gate. The gate to the driveway is moved automatically. There is a gate for persons to enter the front yard. There is a locked storage shed in the back yard. There are not any bodies of water on the premises at the present time. The garage is not accessible from the house; the doors were not locked. LPA reminded the applicant that once they receive residents, if they store toxic or danger items or tools in the garage, it must be kept locked. COMP III orientation was completed with the applicant during this pre-licensing inspection. The following items must be corrected prior to licensure. Submit proof of corrections, along with a copy of this report, to LPA Byrne so that your application may be completed. A follow-up inspection may be scheduled once all corrections are received to ensure compliance with regulation. This report will be sent to the Centralized Application Bureau (CAB) once all corrections are received. You will be notified by the CAB 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 CAB Analyst. Failure to comply could affect approval of your license. Continued on LIC 809C. 87303(c) 87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. 87555(b)(21) 87555 General Food Service Requirements (b) The following food service requirements shall apply: (21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. 87309(a) 87309 Storage Space and Access (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. 87307(d)(4) 87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. 87212(c) 87212 Emergency Disaster Plan (c) Emergency exiting plans and telephone numbers shall be posted.the state’s words, verbatim · CDSS document, May 15, 2025