Facility Evaluation Report

Licensing Program Analysts (LPAs) Salia Walker and Elsie Campos conducted an unannounced Case Management- Deficiencies inspection visit at the facility today due to deficiencies observed during the subsequent visit of complaint control #29-AS-20211129153412.

At 2:11 p.m., the LPAs observed a key inserted on the facility’s front entrance doorknob on the outside. At 2:13 p.m., the LPAs advised staff #1 (S1) the facility entrance key is not to be on the front doorknob for the safety of the residents and staff. S1 immediately removed the facility entrance and acknowledged understanding. At 2:49 p.m., the LPAs advised Administrator Rebeka Durgaryan of the facility key being inserted in the front entrance doorknob. The Administrator acknowledged, and explained the reason for the key being placed on the doorknob is per resident request. The LPAs explained to the Administrator and residents the severity of leaving the facility key on the outside front entrance doorknob, as any one can enter the facility, which poses immediate risk to the residents in care.

At 2:13 p.m., Resident #1 (R1) opened the front door providing access for the LPAs to enter. At 2:13 p.m., S1 rushed to the LPAs stating that S1 was in the middle of changing another resident. During the physical plant tour at 2:15 p.m., the LPAs also observed a mop bucket with water in the common bathroom. S1 stated she was also in the middle of mopping the common bathroom floor, but stepped away to tend to other resident needs. At 2:49 p.m., the Administrator confirmed R1 has Dementia. The LPAs advised the Administrator that upon arrival R1 opened the door for the LPAs as S1 was unable to open the door timely due to being occupied assisting another resident. The administrator acknowledged understanding. Civil Penalties are being assessed today for a Repeat Violation on section 87411(a), as the facility had been cited for the same citation section 87411(a) on 09/14/2021.