Family Connect Memory Care Inc.

On 06/19/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced required Annual Visit to the facility listed above using the CARE Inspection Tool. LPA met with Administrator, Kristine Simonian, and explained the purpose of todays visit. LPA was granted entry into the facility. The facility is licensed to operate for six (6) non-ambulatory residents ages 60 and over with an approved hospice waiver for three (3) residents. Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, garage, laundry room, staff office, side patio, and (2) outside covered patio area. The facility is clean, sanitary, and in good repair. LPA did not observe any bodies of water on the premises. All walkway around the outside of the facility were observed clean, clear, and free of debris, hazards, and obstructions. Bedrooms LPA inspected all resident rooms and observed them to be clean and in good repair. All rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for resident’s personal belongings. All beds were observed with the required linens including a mattress cover, fitted sheet, blanket, comforter, and pillow. LPA observed an ample supply of bed linens stored in closet and in good repair. All bedrooms were observed with ample lighting. Bathrooms LPA inspected all bathroom and observed then within Title 22 regulation and are operable. The showers were observed clean and free of mold and/or mildew. LPA observed showers have non-skid mats and shower chairs available. All safety handrails are secured. LPA observed an ample supply of bath towels stored and in good repair. There is an ample supply of personal hygiene products stored and inaccessible to residents. The water temperature measured 119.3-degrees Fahrenheit. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Kitchen LPA inspected the kitchen and observed it to be clean and sanitry. All appliances are operable and in good repair. LPA observed an ample supply of cookware, dishware, and cutleries. LPA observed a 2-day supply of perishable foods, and a 7-day supply of non-perishable foods properly stored. LPA observed sharps and knives secured in a locked cabinet in the kitchen. LPA observed all cleaning supplies secured in a locked cabinet in the laundry room and an additions supply secured in the garage and are inaccessible to residents. The water temperature measured 118.7-degrees Fahrenheit. Common Areas LPA observed in the living room recliners for resident use. LPA observed a large dining table with chairs to accommodate all residents. The facility was observed appropriately furnished during time of visit. LPA observed games, activities, crafts, and reading material available for resident use. LPA observed all walkways and hallways in the facility were clean, clear, and free of hazards and obstructions. All rooms have ample lighting. The facility was maintained at a comfortable temperature of 74-degrees Fahrenheit. Medications LPA observed medications secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA observed medication in their original packaging. LPA reviewed the medication and Medication Administration Record (MAR) for six (6) residents. LPA observed six (6) out of six (6) resident’s medications are consistent with properly documented record. Files LPA observed resident files are secured in locked cabinet in the staff office and are inaccessible to residents and visitor. LPA reviewed the files for six (6) residents. LPA observed six (6) out of six (6) residents files contain the required documents. LPA reviewed the files for the Administrator and two (2) caregivers. LPA observed they had the required documents, certification, and training. The Administrator’s certificate is valid till 11/21/2026. LPA observed during file review the facilities Licensing Fees are current. Safety LPA observed smoke and carbon monoxide detectors are operable. LPA observed two (2) fully charged fire extinguishers lasted serviced on 01/02/2025. The last fire prevention was conducted by the Torrance Fire Department on 09/20/2024. The last emergency drill was conducted 06/11/2025. LPA reviewed the facility’s liability insurance through Acord that is valid till 03/25/2026. LPA reviewed the Emergency and Disaster Plan for Residential Care Facilities for the Elderly (LIC610E) that was last updated on 01/23/2025. LPA inspected the First Aid kit and observed it contained the required items and a current manual. The facility has an operational landline telephone. All exits are marked with an EXIT sign. All doors have an alarm that chimes when a door exiting the facility is opened. LPA observed all required postings posted in the hallway of the facility. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the entrance of the facility that has a visitor log, hand sanitizer, thermometer, and masks. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA observed all required infection control signs were posted in the facility. During today’s visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Kristine Simonian, and a copy of this report was provided.

On 06/22/24 at 12:15 PM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Administrator/House Manager Kristine Simonian . The facility is licensed to operate for six (6) residents ages 60 and over of which six (6) may be non-ambulatory. The facility is approved for three (3) hospice residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident bedrooms, two (2) bathrooms, living area, dining area, kitchen, side patio, and (2) outside covered patio area. The facility is clean, sanitary, and in good repair. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Bathrooms were checked. Toilets and water faucets worked properly, shower was free of mold/mildew and non-skid strips was in place, hot water temperature properly measured between 109 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards and doorways were free of obstructions. LPA toured the kitchen area and garage and observed a two day supply of perishable and a seven day supply of non-perishable food. The facility cater in lunch 4-5 times during the weekday. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced January 12, 2024 was observed in the hallway near the outdoor exit. Continue to LIC809-C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Administrator tested the carbon monoxide detector and smoke detectors in the house. Devices are interconnected and operational. 5 staff records were reviewed. 5 resident records were reviewed and, 5 out of 5 resident records had medical assessments and pre-appraisal or reappraisals. Two residents’ medication was reviewed. No deficiencies are being cited. An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with Administrator Kristine Simonian .

On 07/18/23, Liciensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced case management visit to the facility listed above. LPA met with Office Manager, Kristine Simonian, and explained the purpose of today's visit. Currently there are 6 Resident's in placement and all 6 Residents were home during the visit. During today's visit, LPA conducted a tour of the facility. During the tour, LPA met with all staff on shift at the facility. LPA confirmed, Staff (S1) is not working at the facility. During file review, LPA found that Staff (S1) was employed at the facility from 10/11/21 through 08/22/22. Staff (S1) was disassociated from the facility on 07/18/23. No deficiencies were observed or cited during today's visit. An exit interview was conduct with Office Manager, Kristine Simonian, and a copy of this report was provided.