Rm Golden Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. Maya Avagyan who is the administrator met with LPA, explained the reason for the visit. At 11:11 AM, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 12/13/2024. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for five (05) non-ambulatory residents, one of which may be bedridden in room #4, hospice waiver is approved for six (6). Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the garage. Bedrooms: There were four (4) bedrooms in the facility, four (4) bedrooms are designated for residents' use. Bedroom #1 and bedroom #4 are used for shared, bedroom #2 and bedroom #3 are private. The bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are two and half (2.5) bathroom in the facility two (2) of the bathroom is for resident use and half (0.5) bathroom is for staff. The bathrooms were properly supplied and has functional fixtures. Hot water temperature was measured at 109.9 degrees Fahrenheit for bathroom #1 located inside beside bedroom #1. Bathroom #2 is located across bedroom #3. Hot water temperature was measured at 110.8 degrees Fahrenheit. Half bathroom is located in between the laundry and dining room that is designated only for staff use. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Office is located beside the kitchen. Fireplace is close, block, and non-operational. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage attached and is used for storage. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the garage. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed all of the client’s files for current appraisal for the residents. Liability insurance a copy was handed to LPA. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Jan 21, 2025

Allegation investigated: Staff prevented resident from leaving the facility. Staff did not seek medical care for resident in a timely manner.

On 6.10.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced subsequent visit to deliver the determination on the above allegations. LPA was greeted by Maya Sargsyan who is the administrator of the facility. An entrance interview was conducted. At 1:33PM LPA conducted a physical plant tour to ensure the health and safety of the residents in care. Allegation: Staff prevented resident from leaving the facility Continue LIC 9099-C Unsubstantiated It was alleged that facility staff prevented resident #1 (R1) from leaving the facility. To investigate the allegations above, LPA conducted an initial visit on 5.06.2024. LPA toured the home and requested and reviewed the staff roster, resident roster, admissions agreement, appraisals, and incident reports. LPA interviewed staff and residents. LPA reviewed medical records on 5.10.2024. Interviews with two (2) staff and two (2) out of (4) residents that the above statement is untrue, and all residents expressed no concern regarding this allegation. The investigation revealed that on 4.27.2024 R1 wanted to go to the library and see family who live in Orange County. R1 proceeded to exit the emergency door to leave the facility. Staff followed the resident and redirected the resident back to the home. R1 was hesitant in returning and decided to sit on the sidewalk and requested that 911 be called for the ambulance to take them to the library and Orange County. S2 was present and advised R1 that an ambulance is only for emergencies. R1 then stated that they were in pain, 911 was called and the resident taken to the hospital. Staff at no time prevented the resident from leaving the facility. Based on the information received this allegation is Unsubstantiated at this time. Allegation: Staff did not seek medical care for resident in a timely manner It was alleged that staff did not seek medical care for R1 in a timely manner. To investigate this allegation, LPA conducted an interview with the staff and residents within the facility and was informed that due to R1 who frequently tries to leave the facility. Staff always re-directed R1 back to the facility, R1 advised staff that they wanted to go to the library or Orange County to visit their family. Interview with two (2) staff and two (2) out of (4) residents that the above statement is untrue, and all residents expressed no concern regarding this allegation. The interview also confirmed that there was no immediate health and safety risk to the resident, therefore 9-1-1 was not called until R1 stated they had hip pain. Ambulance took R1 to Southern California Hospital in Hollywood. From April 27, 2024, R1 was an inpatient, medical records show that R1 was given a series of radiology exams to evaluate the hip for any fracture and the results showed that the injury was old and healed. Based on interviews and record reviews this allegation is deemed unsubstantiated this time. Staff notified emergency services immediately when R1 stated they were in pain. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 10, 2024 · control 31-AS-20240430082015

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda generated this report to address a deficiency observed during the course of a complaint investigation initiated today. While reviewing client records, LPA observed Resident 1 (R1) to NOT have an physician's report and TB test. The rest of the residents has all completed proper paper work. LPA advised licensee that all residents taken in needs to have a complete paper work and TB test. Report reviewed, signed, and delivered. Exit interview conducted, appeal rights issued, deficiency on LIC 809-D page.the state’s words, verbatim · CDSS document, May 6, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: May 20, 2024

Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by; Based on interviews, facility did not have phsycian report which poses a potential health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, May 6, 2024

Plan of correction: Licensee will acknowledge and sendbletter to LPA a letter that moving forward a MD report and TB test should be done.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a)(1) · Plan of correction due date: May 20, 2024

A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious diseases or other medical conditions which would preclude. care of the person by the facility. This requirement is not met as evidenced by; Based on interviews, facility did not have tuberculosis (TB) which poses a potential health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, May 6, 2024

Plan of correction: Licensee will acknowledge and sendbletter to LPA a letter that moving forward a MD report and TB test should be done.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. Ruzanna Avagyan who is the administrator met with LPA, explained the reason for the visit. At 10:00 am, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 5/27/2023. During the visit the facility is at 75 degrees Fahrenheit. The facility is fire cleared for five (05) non-ambulatory residents, one of which may be bedridden in room #4, hospice waiver is approved for 6. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the garage. Bedrooms: There were four (4) bedrooms in the facility, four (4) bedrooms are designated for residents' use. Bedroom #1 is used for shared, bedroom #2, bedroom #3, and bedroom #4 is private. The bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Continue to LIC 809-C Bathrooms: There are three (3) bathroom in the facility two (2) of the bathroom is for resident use and one (1) bathroom is for staff. The bathrooms were properly supplied and has functional fixtures. Hot water temperature was measured at 110.8 degrees Fahrenheit for bathroom #1 located inside beside bedroom #1. Bathroom #2 is located across bedroom #3. Hot water temperature was measured at 111.8 degrees Fahrenheit. Bathroom #3 is in between the laundry and dining room. There was enough clean linen available in the cabinets in the hallway. Common Areas: LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Office is located beside the kitchen. Fireplace is close and non-operational. Furniture in common area was observed to be in good repair. There are no issues with Fire Clearance. Infection control: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. The garage attached and is used for storage and parking. Laundry service: There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the laundry area and is located in the garage. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Continue to LIC 809-C Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current. Resident records were reviewed for requirements and legibility: LPA reviewed all of the client’s files for current appraisal for the residents. Liability insurance a copy was handed to LPA. Planned activities are offered. Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.the state’s words, verbatim · CDSS document, Feb 1, 2024