Mary Ellen Homes

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:29 AM. LPA met with Administrator Gohar Khachatryan. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:30 AM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This included the living room, hallway, and dining area. The living room was observed to be clean and in good repair and contained adequate seating for resident use. The living room contained an adequately screened fireplace and activities for resident use. LPA observed a fire extinguisher mounted in the living room to be fully charged and purchased on 01/26/2026. LPA observed a properly secured medication cart which contained resident medications and a mini refrigerator for medications requiring refrigeration. LPA observed one (1) unlocked hallway closet which contained extra linens and one (1) additional locked hallway closet which contained the facility’s washer and dryer along with cleaning and laundry chemicals. LPA observed the dining area to be clean and properly furnished at the time of the visit. The dining area contained a dining table with adequate seating for resident use. The facility’s combination fire and carbon monoxide alarms along with the facility’s fire door were tested at 09:51 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer which contained knives and other sharp objects. Cont on LIC 809C. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are a dual occupancy resident rooms and two (2) are single occupancy resident rooms. LPA and facility administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #4 is the bedridden approved room and contained a direct exit to the backyard of the facility. LPA observed bedroom #1 to contain an unsecured box of prescription medications. LPA notified the Administrator who secured the medications. BATHROOMS: There are two (2) bathrooms at the facility. One (1) bathroom is designated as private resident bathroom, and one (1) bathroom is designated as a shared resident bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured between 108.3 and 112.3 degrees Fahrenheit, which is in compliance with regulation. OUTDOOR SPACE: The facility has an emergency exit gate located in the front yard; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the facility’s backyard to contain an extra refrigerator and two (2) storage sheds. One (1) shed contained care supplies and one (1) locked shed contained gardening supplies and cleaning chemicals. RECORD REVIEW: Record review began at 10:00 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained all required documentation and trainings. Five (5) resident files were reviewed. Four (4) resident files were observed to contain out of date Appraisal Needs and Services plans (ANS). LPA notified the Administrator that reappraisals shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition. The Administrator expressed understanding and completed updated ANS for the identified residents during the visit. MEDICATION REVIEW: Medication review began at 11:10 AM. Medications for three (3) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. Cont. on LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/26/2026. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. Both residents had no concerns or recommendations for improvement for the facility. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s updated emergency disaster plan, LIC 500, resident roster, and liability insurance. 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.the state’s words, verbatim · CDSS document, Feb 18, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:26 AM. LPA met with Administrator Gohar Khachatryan. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:27 AM, the LPA, along with facility Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. COMMON AREAS: This includes the living room, hallway, and dining area. The living room was observed to be clean and in good repair and contained adequate seating for resident use. The living room contained an adequately screened fireplace and activities for resident use. LPA observed a fire extinguisher mounted in the living room to be fully charged and purchased on 01/22/2025. LPA observed a properly secured medication cart to contain resident medications and a mini refrigerator for medications requiring refrigeration. LPA observed one (1) hallway closet to contain extra linens. LPA observed one (1) additional hallway closet to be appropriately secured making it inaccessible to residents in care. LPA observed this closet to contain the facility’s washer and dryer along with cleaning and laundry chemicals. LPA observed the dining area to be clean and properly furnished at the time of the visit. The dining area contains a dining table with adequate seating for resident use. The facility’s combination fire and carbon monoxide alarms were tested at 09:54 AM and were functional at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. Continued on LIC 809C. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are a dual occupancy resident rooms and two (2) are single occupancy resident rooms. LPA and facility administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedroom #4 is the bedridden approved room and contains a direct exit to the backyard of the facility. BATHROOMS: There are two (2) bathrooms at the facility. One (1) bathroom is designated as private resident bathroom, and one (1) bathroom is designated as a shared resident bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured between 118.2 and 118.9 degrees Fahrenheit, which is in compliance with regulation. OUTDOOR SPACE: The facility has two (2) emergency exit gates. Both are located in the front yard; LPA observed clear passageways for emergency exit use. The facility has adequate shaded seating outdoors for resident use. LPA observed the facility’s backyard to contain two (2) extra refrigerators and two (2) storage sheds. One (1) shed was observed to be appropriately secured and contained gardening supplies. The additional shed was observed to contain extra care supplies. RECORD REVIEW: Record review began at 10:00 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Three (3) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed. Two (2) resident files were observed to be missing negative Tuberculosis (TB) tests. One (1) resident’s physician report indicated that the resident was unable to leave the facility unassisted. At the time of the inspection LPA did not observe the resident in the facility. The Administrator informed LPA that the resident goes on walks by themselves in the mornings and confirmed that a staff member was not accompanying the resident. LPA informed the Administrator that this resident is unable to leave the facility unassisted. The Administrator and agreed to follow the physician’s orders until a licensed medical professional re-evaluates the resident’s ability to leave the facility unassisted. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 11:57 AM. Medications for five (5) of five (5) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. LPA observed three (3) resident’s medications to be prepared for the week utilizing Monday-Sunday medication organizers. LPA informed the Administrator that transferring medications between containers is not permitted. The Administrator removed the medications from the organizers and agreed to not prepare resident medications more than 24 hours in advance. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/18/2025. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them very well and are attentive to their needs. Both residents had no concerns or recommendations for improvement for the facility. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. 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.the state’s words, verbatim · CDSS document, Feb 19, 2025

Allegation investigated: Staff did not prevent an altercation between residents

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 9:25 a.m., the LPA met with Administrator, Gohar Khachatryan and explained the reason for the visit. At 9:36 a.m., the LPA along with the Administrator conducted a physical plant tour. Between 9:37 a.m. and 10:00 a.m., the LPA conducted interviews with the Administrator, one (1) staff and five (5) residents. At 9:46 a.m., the LPA obtained copies of pertinent documents. Continued on LIC 9099-C. Unsubstantiated Regarding the allegation: Staff did not prevent an altercation between residents. It was alleged that staff did not prevent Resident #1 (R1) from pushing Resident #2 (R2). On 05/24/2024, R1 pushed R2 causing R2 to fall. The Administrator called the paramedics as soon as the caregiver reported R1 and R2’s altercation. R1 is diagnosed with dementia. The Administrator revealed that R1 was admitted to the facility on 05/23/2024 and started to show aggression towards staff once R1’s family left the facility. The Administrator believes that R1’s aggression was due to R1 not being familiar with the facility. The Administrator said that R1 and R2 were separated immediately, and paramedics transported R2 to the hospital. R2 returned to the facility on the same day with no head injuries noted. The Administrator said that she contacted R1’s and R2’s families and physicians. The Administrator explained that R1’s physician adjusted R1’s medication. The Administrator stated that since the altercation, R1 and R2 have not had any other issues or altercations. The Administrator said that R1 has adjusted to the facility and is no longer demonstrating aggressive behavior. During the time of the visit, the LPA conducted interviews with five (5) residents, including R1 and R2. R2 stated that there are no issues between R2 and R1. The interviews with residents revealed that all residents get along with one another and that if there were issues staff intervene to prevent further issues. No concerns were brought up during the resident interviews. Interview with Staff #1 (S1) revealed that S1 immediately reported the altercation to the Administrator and the Administrator called the paramedics. S1 stated that R1 has been happy and hasn’t had anymore altercations with R2. Although R1 pushed R2 while in care, the Administrator and staff did not anticipate R1’s aggression as R1 was newly admitted and was struggling to adjust to the new environment. Additionally, the Administrator and staff reacted appropriately and ensured R1 and R2’s safety. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 4, 2024 · control 29-AS-20240528163431

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena, arrived at the facility unannounced to conduct a required annual inspection. LPA Urena arrived at the facility at 11:00 a.m. and was greeted by the staff. Staff call the administrator to announce the LPA’s visit. The administrator arrived shortly thereafter, and the LPA explained the reason for the visit. At 11:25 a.m., LPA Urena and the administrator conducted a tour of the inside and outside the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 70 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was last serviced on 12/01/2023. The LPA observed required postings throughout the common space. KITCHEN: Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Emergency food supply is adequate for six residents and two staff. BEDROOMS: were observed to be furnished appropriately with appropriate furnishings, and sufficient lighting. Linens are clean and in good condition. BATHROOMS: Bathrooms were observed to be clean; shower area was in clean condition with grab bars and a non-skid mat available. Paper towels were available for drying hands. Hand washing signs were displayed, and sufficient amounts of soap and paper products in each restroom. Continues on LIC 809C... OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for client use and is single-latched. No bodies of water noted. The washer and dryer are in a locked closet between bedrooms 2 and 4. Cleaning supplies and disinfectants are kept in locked in the laundry closet. RECORDS: Records review began at 1:00 p.m., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 1:45 p.m.; medications are centrally stored and locked in a cabinet; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: The facility has 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 LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 6, 2024