Facility Evaluation Report

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced Case Management – Deficiencies visit at the facility today. LPA arrived to the facility at 02:02 PM and met with facility staff Tatyana Sevostyanova. Facility staff contacted the facility Administrator Elba Khachatryan via telephone call. The facility Administrator arrived to the facility at approximately 02:30 PM. Entrance interview conducted and the reason for the visit was explained.

During today’s visit between 02:05 PM and 03:15 PM LPA conducted a physical plant tour, conducted a file review for six (6) residents, interviewed two (2) residents and collected copies of resident documentation.

During file review LPA observed resident #1’s (R1)’s physician report to be missing a signature from a licensed medical professional acting within their practice. LPA informed the Administrator who stated that the physician’s report came from a different nursing home and agreed to obtain a copy of the report with the licensed medical professional’s signature on the bottom of the sheet. LPA observed R1’s file to be missing a pre-admission appraisal. LPA informed the Administrator who stated that they did conduct an interview with R1 but they have not completed the paperwork yet. LPA informed the Administrator that facilities are responsible for documenting, in writing the findings of the pre-admission appraisal, and any reappraisal or assessment. The Administrator agreed to complete R1’s pre-admission appraisal and send a copy to LPA once completed.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.