A-1 Boarding Care

Allegation investigated: Resident sustained injuries while in care Staff did not ensure resident was seen by a physician Staff did not administer residents medication

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to the deliver findings for the allegation listed above. Upon arrival LPA met with staff and explained the reason for the visit. The licensee Hovhannes Ispiryan arrived shortly thereafter. During the investigation, LPA conducted a physical plant tour virtually on 01/25/2021, obtained documents and interviewed the Administrator. Subsequent visits were conducted on 06/10/2021 and 08/23/2021 to conduct interviews with staff, residents, responsible parties and obtain additional documents as well as deliver findings on other allegations related to this complaint. LPA made multiple attempts to contact reporting party to obtain additional information on 01/25/2021, 01/26/2021, 08/23/2021, and 02/28/2023, but was unsuccessful. It was reported that resident sustained injuries while in care, as it was alleged that Resident 1 (R1) was observed to have wounds and bruising on their left arm. Unsubstantiated Continued from 9099 LPA’s interview with R1’s Private Caregiver 1 (PC1), revealed they assisted R1 with bathing, grooming and dressing at the facility at least twice a week. Interviews further revealed PC1 had never observed any wounds or bruising on R1 while R1 was in care at the facility. LPA interview with Administrator and staff along with records review of R1’s file revealed there was never an observation of wounds or bruising on any part of R1’s body. LPA was unable to obtain additional information from reporting party regarding this allegation. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that R1 was ever observed with wounds and bruising. Therefore, the allegation that resident sustained injuries while in care has been deemed UNSUBSTANTIATED at this time. It was reported that Staff did not ensure resident was seen by a physician, as it was alleged that R1 had not been to a doctor in over a year. LPA records review of R1’s file revealed, that according to physician’s reported dated 08/14/2018, R1 had the following diagnoses and health conditions, COPD exacerbation, blindness, Non-Ambulatory, able to communicate needs, follow instructions and needed some assistance with self-care. File review further revealed there was nothing notated in the change of R1’s health condition upon admittance that would require Licensee to conduct a reappraisal. LPA interview with PC1 and staff, revealed PC1 drove R1 to doctor’s appointments multiple times throughout R1’s stay in the facility. LPA was unable to obtain additional information from reporting party regarding this allegation. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that R1 had not been to a doctor in over a year. Therefore, the allegation that staff did not ensure resident was seen by a physician has been deemed UNSUBSTANTIATED at this time. It was reported that staff did not administer resident’s medication, as it was alleged that staff were not aware of what two (2) medications R1 needed to take. LPA records review of R1’s file and most current centrally stored medication log revealed that prescription Quetiapine Fumarate 25mg, quantity 90 was prescribed to be taken once nightly. The prescription Trazadone 50mg quantity 45 was prescribed for R1 to take ½ a tab at bedtime. No Medication Administration Record on file for LPA to review. LPA interview with PC1 revealed PC1 did not express any concerns of R1 not being administered medication while in care. Interview further revealed PC1 has observed staff administer medications to R1 on multiple occasions. LPA’s interview with family member / responsible parties of residents in care revealed that each were satisfied with the services of the facility staff and each did not express any immediate or potential concerns of staff not being aware of what medications to administer to the residents in care. Continued from 9099-C LPA was unable to obtain additional information from reporting party regarding this allegation. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that staff were not aware of what two (2) medications R1 needed to take. Therefore, the allegation that staff did not administer resident’s medication has been deemed UNSUBSTANTIATED at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Mar 10, 2023 · control 29-AS-20210120163102

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a required annual visit. The LPA met with staff and explained the reason for the visit. The licensee Hovhannes Ispiryan arrived shortly thereafter. The LPA toured the facility to ensure there are no health and safety hazards and to ensure regulatory compliance. KITCHEN: Knives and chemicals are locked inaccessible. Appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The resident rooms were furnished appropriately; beds had with clean linens and rooms had sufficient lighting. All direct exits were clear and no obstructions were noted. RESTROOMS: Restrooms were clean and sanitary with grab bars and non-skid surfaces. At 10:32 a.m., water temperature measured at 108.2 F. Restrooms were fully stocked. Hand-washing signs were observed. COMMON SPACES: Living room and dining room furniture were observed to be in good condition. The facility maintained a temperature of 73 degrees. Fire extinguishers were fully charged and purchased 4/2022. All exits have functioning auditory devices. The backyard had furniture and a covered area for resident use. The side gate door was self-latching. No bodies of water noted. INFECTION CONTROL: There was a central entry point for symptom screening and temperature checks. The LPA was appropriately screened upon entry into the facility. Staff were wearing appropriate face coverings. Infection Control signs were observed on the front door and throughout the facility. Facility has a sufficient supply of PPE. The facility’s cleaning protocol is sufficient. There was record of staff and resident vaccinations. The LPA discussed changes around testing, visitation and vaccine requirements. The facility's procedures as it pertains to infection control are adequate. CONT 809-C At the time of the visit, the LPA observed a dwelling being built in the backyard. The Licensee stated that it is a dwelling that will be for the licensee to live in. The licensee claimed that the dwelling will have a separate address, and it will be separate from the main facility. The LPA inquired as to whether they obtained city permits for the new dwelling, in which the Licensee confirmed. The LPA advised the Administrator that the permits would need to be submitted to CCL, along with a proposed timeline of completion. The Licensee said they would do so; during the visit, the Licensee emailed the permits to the LPA. The Licensee anticipates that the dwelling will be complete by the end of the year, and that construction will not interfere with the operation of the licensed facility. No deficiencies cited at this time. Contact information was confirmed during today's visit. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 12, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Salia Walker arrived at the facility unannounced to conduct a required Annual visit at 1:15 p.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Designee Gohar Shahinyan at 1:22 p.m. and explained the reason for the visit. The LPA toured the physical plant areas inside and outside, with the Gohar Shahinyan at 1:27 p.m., to ensure there are no health and safety hazards. BEDROOMS: The LPA observed the resident bedrooms which were furnished with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap, paper products, and hand-washing signs in each restroom. Between 1:33 p.m. to 1:40 p.m., hot water temperatures measured between 113.5 and 117.8 degrees Fahrenheit in the common and private bathroom(s). At 1:28 p.m., the LPA observed there were accessible cleaning supplies and chemicals in common bathroom #1. The Designee secured it at the time of observation. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies in kitchen were observed to be properly stored and locked at time of visit. Hot water measured 116.8 Fahrenheit at 2:32 p.m. At 1:45 p.m., the LPA observed five (5) out of six (6) resident medications in kitchen cabinet were prepared for more than 24 Hours. The LPA advised the Designee that per Title 22 Regulation each resident's medication shall be stored in its originally received container, and no medications shall be transferred between containers. From 2:40 p.m. until 3:45 p.m., the LPA conducted a Medication assessment with Designee Gohar Shahinyan. All medication was counted for, and placed back into its original container. Continue on LIC 809C.. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed required postings in the hallway near the living room. One fire extinguisher was observed to be fully charged and purchased on 05/2021. The cabinets next entrance door contains additional nonperishable and perishable food items. BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The garage is detached to the facility. The garage is used as storage for addition supplies. INFECTION CONTROL: During today’s visit, the LPA spoke with the Designee regarding the facility’s infection control practices. Upon entry, the facility had a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time and the LPA reviewed facility’s policies and procedures as it pertains to infection control. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 11, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Oct 11, 2021

87705 Care of Persons with Dementia: (f)The following shall be stored inaccessible to residents with dementia: (2)Over-the-counter medication.. alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on LPA's observations, the licensee did not comply with the section cited above, as cleaning supplies and disinfectants were found accessible in the facility's common restroom, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 11, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Oct 11, 2021

87465 Incidental Medical and Dental Care:(h)The following requirements shall apply to medications which are centrally stored: (5)Each resident's medication shall be stored in its originally received container.. This requirement is not met as evidenced by: Based on LPA's observation and medication assessment, the lincensee did not comply with the section cited above, as five (5) out of six (6) resident medications were removed from its original container and prepared for more than 24-Hours, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 11, 2021

Allegation investigated: Residents file is missing emergency documents Staff threatened to evict resident Staff did not safeguard residents personal belongings Staff did not prevent inappropriate room accommodations

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent visit for the above allegation. LPA met with Hovhannes Ispiryan and explained the reason for the visit. During the investigation, LPA conducted a physical plant tour virtually on 01/25/2021 as well as interviewed Administrator. On 6/10/2021, LPA conducted interviews with facility staff, and other relevant parties. LPA also gathered and reviewed facility documentation pertinent to the allegation. It was alleged that Residents file is missing emergency documents, LPA records review of all residents in care as well as Resident 1 (R1), revealed that each resident folder appeared to have all the appropriate documents at this time. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that residents file is missing emergency documents at this time. Therefore, the above allegation is UNSUBSTANTIATED at this time. (Continued on 9099-C) Unsubstantiated Continued from 9099 It was alleged that Staff threatened to evict resident, LPA interview with residents in care revealed that all have not witnessed staff ever threatened to evict another resident. Each resident also stated they have not been threatened with eviction as well. LPA records review revealed that an eviction notices was never issued to R1. Based on information gathered during this and previous visit, the department does not have sufficient evidence to determine that staff threatened to evict resident. Therefore , the above allegation is UNSUBSTANTIATED at this time. It was alleged that staff did not safeguard resident’s personal belongings, LPA interview with residents in care revealed that each resident did not express any immediate concerns that staff are not safeguarding their personal belongings. Interviews with residents also revealed that most have never had any of their personal items missing. LPA records review revealed that each resident has completed their client/resident Personal Property and Valuables form. Based on information gathered during this and previous visit, the department does not have sufficient evidence to determine that staff did not safeguard residents personal belonging. Therefore, the above allegation is UNSUBSTANTIATED at this time. It was alleged that staff did not prevent inappropriate room accommodations, LPA interview with residents in care revealed that each resident was satisfied with their room accommodations. Interviews with residents further revealed that no resident has ever witnessed any staff members storing their personal belongings in resident bedrooms or sleeping in any of the resident bedrooms. LPA records review revealed there is no live in staff on file at this time. Based on information gathered during this and previous visit, the department does not have sufficient evidence to determine that staff did not prevent inappropriate room accommodations. Therefore , the above allegation is UNSUBSTANTIATED at this time. Exit interview conducted. Report issued and sent to Administrator via email.the state’s words, verbatim · CDSS document, Aug 23, 2021 · control 29-AS-20210120163102

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.