Vagthol's Residential Care Center #2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Required - 1 Year annual inspection visit. LPA met with Elizabeth Romero-Administrator and explained the purpose of the visit. The program is vendorized through the Frank D. Lanterman Regional Center. This residential care facility for elderly (RCFE) has fire clearance approval for a maximum capacity of six (6) residents, ages 60 and above, of which six (6) may be non-Ambulatory, with hospice waiver approval for six (6) residents. LPA toured the facility with the Administrator at 11:15 am and observed the following: Required postings were observed in the hallway and the kitchen. The front entry is the main exit door but there are exits in the kitchen and the living room, leading to the backyard. Each of the bedrooms also have exit doors with alarms on each door. There are three fire extinguishers, one in the living room, one in a closet and one in the kitchen. All three fire extinguishers are fully charged as of 10/18/2024. Facility conducts monthly fire and safety drills, and quarterly earthquake drills. The last fire drill was conducted on 09/09/2025 and earthquake drill was conducted on 10/07/2025. The smoke and carbon monoxide detectors are interconnected with the Burbank Fire Department. The detectors were tested on 09/09/2025; therefore LPA did not test the smoke and carbon monoxide detectors. Kitchen: The kitchen appliances consisted of a refrigerator, stove, oven, dishwasher and microwave and the fixtures were observed to be functional. Knives, sharp kitchen objects and cleaning supplies are stored in locked kitchen cabinet. LPAs found a sufficient supply of perishable foods (2 days) and non-perishable food (7 days) supplies, with sufficient amount of dishes. All kitchen surfaces and cabinets were observed to be clean and sanitary. Continued on 809-C Common Areas: There is a sitting area by the entry door with additional chairs, tables in the living room and dining rooms, appropriate number of clients. A television set and cabinets with activity/gaming areas were observed in the living room. There are several closets in the hallway, used to store incontinence supplies and linens. Bathrooms: There are three (3) bathrooms designated for residents and staff use. All toilets and sinks are maintained in sanitary, operating condition. LPA observed proper grab bars and non-skid mats in both bathrooms. Hot water temperature in resident bathrooms were measured at 110.5 through 113.2 degrees Fahrenheit. Bedrooms: There are six (6) private bedrooms designated for clients' use. All the bedrooms have exit doors with functional alarm chimes. All of the bedrooms were properly furnished with appropriate chairs, beddings. television sets, linens with sufficient lighting. Surrounding grounds: The entrance to the home is gated. There is a water fountain at the front yard but there is no pool. LPA observed two sets of patio tables and chairs underneath covered patio. There are gardening and flower beds, where residents grow plants. Facility has an electrical generator in the backyard. Entry/exit gates and pathways were free of obstruction and free of visible immediate hazards. Facility has no garage but has several carports accessed through the back alley. The laundry room is located outside in the backyard and divided with a locked door. The washer/dryer appear to be in good condition. Laundry detergents/chemicals are kept inaccessible in a locked cabinet. Continued on 809-C Office/Staff Break Room: Staff break room is located by the front entry door. Staff files kept locked in an office in the backyard. Staff Files: Staff files were reviewed to ensure all forms and training certificates are up to date. First-Aid Kit/Medications: All medications were observed to be locked in a cabinet inside the kitchen pantry. In the same cabinet, LPA observed a complete first-aid kits with all required supplies and the first aid manual. Resident Files/Medications: A review of resident records to ensure compliance of licensing forms was conducted. Medications records for residents were also verified for accuracy of administration based on physician orders. LPA counted medications for 6 out of 6 residents to ensure accuracy of administration vs. physician's orders. P&I for residents were also counted and compared to receipts and records. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted / A Copy of the Report provided to Administrator.the state’s words, verbatim · CDSS document, Oct 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Elizabeth Romero for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 9:00a.m. and the following was noted: There is one entrance being utilized at the facility. The facility has a total of six (06) bedrooms and three (03) bathrooms. The facility is fire cleared for six (06) non-ambulatory and a hospice waiver for six (06). The facility is currently occupying six (06) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 73°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguishers located throughout the facility and observed to be fully charged. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 112.7°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 18, 2024