Omnicare II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility to conduct a required annual inspection. LPA was greeted by staff and informed them of the reason for the visit. Administrator Laila Kulungu was called and reason for the visit was explained. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer in the kitchen. The facility has a sufficient supply of perishable and non-perishable food. Appliances in the kitchen were clean and functional. There is an adequate supply of emergency food and water. Medications are stored in a locked kitchen cabinet and files are stored in a locked filing cabinet in the office area next to the kitchen. GARAGE/ LAUNDRY: The attached garage by the kitchen is kept locked. LPA observed the pantry, an additional refrigerator/freezer, and a washer and dryer. Laundry detergent and chemicals are stored inaccessible in the garage. BEDROOMS: There are six (6) bedrooms in the facility; all bedrooms for resident use are private. There is no staff room in the facility as there is no live in staff. Three (3) of six (6) rooms have direct access to the outside. Lighting in the rooms is adequate. All resident rooms were set up with beds, night stands, lighting, chests of drawers, chairs and closet space. Full rail observed on resident #1's (R1) bed. R1 is not on hospice. BATHROOMS: There are three (3) full bathrooms. There are two (2) private bathrooms for resident use and one (1) hallway bathroom for resident use. The showers are equipped with nonskid surfaces and nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature in bathrooms measured between 106.9 – 111.7 degrees Fahrenheit, which is within the required range. COMMON AREAS: Common areas were appropriately furnished and in good condition. The facility smoke alarm system is hard wired; smoke detectors were tested and were operable at the time of the visit. (Continue to LIC809c) Fire extinguisher located in the kitchen was observed fully charge with receipt dated 10/16/2024. Administrator stated she will have a new fire extinguisher at the facility by Monday, 10/20/2025. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted in the main hallway area wall. Other required postings are also posted on the main hallway area wall. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located directly outside the sliding doors from the living room. There is a gated and locked pool in the backyard. The facility has a self-latching exit gate located on both side passageways. The garage is attached to the property and is used for additional storage, emergency supplies, additional food and laundry. RECORD REVIEW: Records review began at 12PM-1:30PM. LPA observed all four (4) resident records for documents including, but not limited to: needs and service appraisals, medical records, admissions agreement, and consent forms. LPA observed three (3) personnel records for documents including, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Personnel files reviewed were in order and had no missing documents. At 12:30PM, LPA observed three (3) out of four (4) resident files to be missing a PRN Authorization letter from the physician for resident #2, #3 and resident #4. MEDICATIONS: Medications are stored inaccessible in locked cabinets in the kitchen and office area. Beginning at 2PM, LPA observed medications for two (2) residents. Medications were observed to be properly documented on the centrally stored medications and destruction record and were in compliance with regulation, state, and federal law. INFECTION CONTROL: 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 it pertains to infection control are adequate. Emergency disaster drills are not conducted quarterly as is required. Staff conducted a fire drill during the visit. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual inspection at 09:40AM. LPA was greeted by staff and informed them of the reason for the visit. Administrator Laila Kulungu arrived at 10:36AM. The LPA and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: LPA toured the kitchen at 09:45AM. Kitchen knives are stored locked and inaccessible in a drawer in the kitchen. The facility has a sufficient supply of perishable and non-perishable food. Appliances in the kitchen were clean and functional. There is an adequate supply of emergency food and water. Medications are stored in a locked kitchen cabinet and files are stored in a locked filing cabinet in the office area next to the kitchen. GARAGE/LAUNDRY: The attached garage by the kitchen is kept locked. LPA observed the pantry, an additional refrigerator/freezer, and a washer and dryer. Laundry detergent and chemicals are stored inaccessible in the garage. BEDROOMS: There are six (6) bedrooms in the facility; all bedrooms for resident use are private. There is no staff room in the facility as there is no live in staff. Three (3) of six (6) rooms have direct access to the outside. Lighting in the rooms is adequate. All resident rooms were set up with beds, night stands, lighting, chests of drawers, chairs and closet space. Report continued on LIC-809C. BATHROOMS: There are three (3) full bathrooms. There are two (2) private bathrooms for resident use and one (1) hallway bathroom for resident use. The showers are equipped with nonskid surfaces and nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature in bathrooms measured between 108.5 – 114.5 degrees Fahrenheit, which is within the required range. COMMON AREAS: These include the office area, dining area, and living room. Common areas were appropriately furnished and in good condition. The facility smoke alarm system is hard wired; smoke detectors were tested at 10:06AM and were operable at the time of the visit. There is one (1) fire extinguisher which was fully charged and last purchased on 10/16/2024. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted in the main hallway area wall. Other required postings are also posted on the main hallway area wall. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located directly outside the sliding doors from the living room. There is a gated and locked pool in the backyard. The facility has a self-latching exit gate located on both side passageways. The garage is attached to the property and is used for additional storage, emergency supplies, additional food and laundry. MEDICATIONS: Medications are stored inaccessible in locked cabinets in the kitchen and office area. Beginning at 10:11AM, LPA observed medications for two (2) residents. Medications were observed to be properly documented on the centrally stored medications and destruction record and were in compliance with regulation, state, and federal law. RECORD REVIEW: Records review began at 10:29AM. LPA observed all four (4) resident records for documents including, but not limited to: needs and service appraisals, medical records, admissions agreement, and consent forms. LPA observed three (3) personnel records for documents including, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All resident files were in order and had no missing documents. At 10:57AM, LPA observed two (2) out of three (3) personnel files to be missing 20 hours annual training. Report continued on LIC-809C. INFECTION CONTROL: 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 it pertains to infection control are adequate. Emergency disaster drills are not conducted quarterly as is required. Staff conducted a fire drill during the visit. INTERVIEWS: During today’s visit, LPA interviewed two (2) residents and three (3) staff. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct deficiencies may result in civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 24, 2024

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility announced at 9:40 a.m. to conduct a pre-licensing inspection. This is a change of ownership application from Omnicare II (#565801460) to Omnicare II (#565850312). The LPA met with Administrator Laila Kulungu. All rooms are cleared for non-ambulatory residents. The fire clearance was granted on 5/3/2023; in which bedridden residents are permitted in Bedroom #3. Component III was waived as the applicant currently operates two other Residential Care Facilities for the Elderly (RCFE)’s that are currently in good standing. Component III was successfully completed on 8/28/2023. At 9:55 a.m., the LPA toured the physical plant areas inside and outside with the applicant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer in the kitchen. The supply of nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean and functional. There is an adequate supply of emergency food. Medications are stored in a locked kitchen cabinet and files are stored in a locked filing cabinet in the office area next to the kitchen. BEDROOMS: There are (6) six bedrooms in the facility; all bedrooms for resident use are private. There is no staff room in the facility as there is no live in staff. Three (3) of six (6) rooms have direct access to the outside. Lighting in the rooms is adequate. All resident rooms were set up with beds, night stands, lighting, chests of drawers, chairs and closet space. BATHROOMS: There are (3) full bathrooms. There are (2) private bathrooms for resident use and (1) hallway bathroom for resident use. The showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in the bathrooms. Hot water temperature in bathrooms measured between 108.6-115.8 degrees Fahrenheit. Continued on LIC 809-C COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment in the living room area. There is a covered fireplace. The facility smoke alarm system is hard wired; the smoke detectors were operable at the time of the visit. There is (1) fire extinguisher which was fully charged and last purchased on 8/31/2023. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted in the main hallway area wall. Other required postings are also posted on the main hallway area wall. MEDICATIONS: Medications are in a locked medication cabinet in the kitchen. The first aid supplies were complete, including a first aid manual. FILES: Resident and staff records are stored in a locked filing cabinet in the office area next to the kitchen. LAUNDRY: The laundry area is in the attached garage. Laundry detergent and chemicals are stored inaccessible in the garage. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area with tables and chairs for resident use located directly outside the sliding doors from the living room. There is a gated and locked pool in the backyard. The facility has a self-latching exit gate located on both side passageways. There is no front yard gate or driveway gate. The garage is attached to the property and is used for additional storage, emergency supplies, additional food and laundry. INFECTION CONTROL: The facility has a central entry point for symptom screening and sanitation station for staff, residents, and visitors. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Facility is in compliance with Title 22 Regulations at this time. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Oct 18, 2023