Inspection Report Summary
Most inspections found deficiencies, but the facility has shown some improvement over time. The most recent report from January 16, 2025, noted only one deficiency related to the use of full bed rails for a resident not on hospice care, which poses a potential safety risk. Earlier reports cited more issues, including medication labeling and storage problems, incomplete staff training, and water temperature concerns, but no fines or enforcement actions were listed in the available reports. A complaint investigation in June 2022 was unsubstantiated. While some deficiencies involved resident care and staff training, recent findings suggest the facility is addressing these areas.
Deficiencies per Year
8
6
4
2
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Jan 16, 2025
Visit Reason
An unannounced annual inspection was conducted using the CARE inspection tool to evaluate compliance with licensing regulations.
Findings
The facility was found to be in good repair with clean and sufficient living areas, adequate food supplies, and proper safety measures. However, a deficiency was noted regarding the use of full bed rails for a resident not on hospice care, which poses a potential health and safety risk.
Deficiencies (1)
| Description |
|---|
| Resident #2's bed was observed with full bed rails despite not being on hospice care, which is prohibited and poses a potential health, safety, or personal rights risk. |
Report Facts
Residents present: 6
Licensed capacity: 6
Plan of Correction due date: Jan 23, 2025
Fire extinguisher last checked: Oct 8, 2024
Last fire drill: Nov 6, 2024
Water temperature: 118.5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Fontecha | Caregiver | Met with during inspection and facility tour |
| Mariam Nikogsyan | Participated in exit interview and received report and appeal rights | |
| Tony Vasallo | Supervisor | Named as supervisor and involved in report process |
| Mary G Flores | Licensing Evaluator | Conducted inspection and signed report |
| Nicol Wesley | Licensing Program Analyst | Conducted inspection |
| Juan Fontecha | Accompanied LPAs during facility tour | |
| Diana Castellanos | Administrator | Administrator certificate observed |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 7
Dec 2, 2023
Visit Reason
An unannounced annual visit was conducted using the CARE inspection tool to evaluate compliance with licensing regulations for a residential care facility for the elderly.
Findings
The facility was generally in good repair and clean, but several deficiencies were noted including medication labeling and storage issues, water temperature below required levels, missing pre-admission appraisal for a resident, lack of posted complaint information, and incomplete staff training records.
Severity Breakdown
Type A: 2
Type B: 5
Deficiencies (7)
| Description | Severity |
|---|---|
| Resident #4's medication was observed without a prescription label which poses an immediate health, safety or personal rights risk. | Type A |
| Resident #4's medication was not stored in its original container, posing an immediate health, safety or personal rights risk. | Type A |
| Water temperature in bathroom tested at 86.3 degrees F, below the required 105-120 degrees F, posing a potential health, safety or personal rights risk. | Type B |
| Resident #3 does not have a pre-admission appraisal on file, posing a potential health, safety or personal rights risk. | Type B |
| Poster (PUB 745) was not posted in the facility, posing a potential health, safety or personal rights risk. | Type B |
| 4 out of 5 staff files reviewed did not have initial training provided for staff #2-#5, posing a potential health, safety or personal rights risk. | Type B |
| 4 out of 5 staff files reviewed did not have 20 hours of annual training for staff #2-#5, posing a potential health, safety or personal rights risk. | Type B |
Report Facts
Capacity: 6
Census: 5
Water temperature: 86.3
POC Due Date: Dec 4, 2023
POC Due Date: Dec 8, 2023
Staff files missing initial training: 4
Staff files missing annual training: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Hakob Gevorkyan | Caregiver | Met with Licensing Program Analyst during inspection |
| Nvard Gevorkian | Administrator | Named in exit interview and responsible for corrective actions |
| Mary G Flores | Licensing Program Analyst | Conducted the inspection and authored the report |
| Tony Vasallo | Supervisor | Supervisor overseeing the licensing evaluation |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 1
Nov 29, 2022
Visit Reason
An unannounced annual visit was conducted focusing on infection control, medication, and food review.
Findings
The facility was generally clean and in good repair with sufficient food and safety equipment; however, a deficiency was noted due to the lack of physician's orders for half bed rails for two residents, posing an immediate health and safety risk.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Lack of physician's orders for half bed rails for residents #3 and #4. | Type A |
Report Facts
Residents observed with half bed rails without physician's orders: 2
Residents reviewed for medication: 3
Resident files reviewed: 5
Staff files reviewed: 3
Facility capacity: 6
Current census: 6
Water temperature: 114.6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nvard Gevorkian | Administrator | Named in relation to the inspection and deficiency findings |
| Mary G Flores | Licensing Program Analyst | Conducted the inspection |
| Melanya Khachatryan | Caregiver | Met with Licensing Program Analyst during inspection |
Inspection Report
Complaint Investigation
Census: 6
Capacity: 6
Deficiencies: 0
Jun 21, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit regarding an allegation that the facility was not allowing residents to choose the Hospice service of their choice.
Findings
The investigation found insufficient evidence to support the allegation. Interviews and document reviews showed that residents are allowed to choose their hospice agency, and the alleged resident was not found to reside at the facility. The complaint was determined to be unfounded and dismissed.
Complaint Details
The complaint alleged that the facility was not allowing residents to choose their hospice service. The complaint was investigated and found to be unfounded, meaning the allegations were false or without reasonable basis.
Report Facts
Residents interviewed: 5
Residents under hospice care: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mary G Flores | Licensing Program Analyst | Conducted the complaint investigation visit. |
| Nvard Gevorkian | Administrator | Met with Licensing Program Analyst and provided information during the investigation. |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Feb 7, 2022
Visit Reason
Licensing Program Analyst Mary Flores conducted an unannounced annual visit focusing on infection control, medication, and food review.
Findings
The facility was found to be in compliance with no deficiencies cited. Observations included proper food supplies, locked sharps and chemicals, adequate lighting and furniture, safe water temperature, working smoke/carbon monoxide detectors, and adherence to COVID-19 screening recommendations.
Report Facts
Residents present: 6
Licensed capacity: 6
Water temperature: 111.7
Medication review: 2
Staff files reviewed: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nvard Gevorkian | Administrator | Administrator present during inspection and named in report |
| Lida Gasparyan | Caregiver | Caregiver present during inspection and named in report |
| Mary Flores | Licensing Program Analyst | Conducted the inspection visit |
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