Monogram Villa

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Type of visit: Collateral

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced Collateral inspection at the above listed facility at 9:50 a.m. due to a complaint unrelated to this facility. LPA was greeted by staff who called the Administrator to inform them of the reason for the visit. LPA met with Angela Krbashyan, Licensee representative telephonically and the reason for the visit was explained. Entrance interview conducted. During today’s visit LPA conducted a physical plant tour to ensure there are no immediate health and safety concerns and interviewed staff #1 (S1). Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 19, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced Case Management inspection as the facility requested a capacity and hospice waiver increase from six (6) to twelve (12). The LPA arrived at 9:11AM and met with the Licensee Angela Krbashyan who arrived shortly thereafter. Entrance interview conducted. Beginning at 9:24AM, the LPA and Licensee conducted a physical plant tour. The facility had nine (9) resident bedrooms: six (6) private bedrooms and three (3) shared bedrooms. The facility was approved for a total of twelve (12) bedridden residents. There was a total of eight (8) restrooms: seven (7) private resident restrooms and one (1) shared common area restroom located in the hallway. The LPA observed sufficient space inside the bedrooms and in the common areas to accommodate residents’ activities and the increase in capacity. There were three (3) outdoor areas: one (1) front yard, one (1) rear yard, and one (1) courtyard. The front and rear yard had entrances and exits for everyday use and in the event of an emergency. All passageways were free of obstruction. Fire extinguishers were observed throughout the facility and were fully charged and serviced or recently purchased. Effective 12/18/2025, the facility was issued a new license reflecting the capacity and hospice waiver increase. The Licensee was provided a signed copy of their license in addition to the hospice waiver increase approval letter. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Dec 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:35AM. The LPA was greeted by Staff, informed them of the reason for the visit, and staff proceeded to notify the Licensee. The Licensee Angela Krbashyan arrived shortly thereafter. Entrance interview conducted. Beginning at 9:52AM, the LPA and Licensee toured the physical plant areas inside and outside to ensure there were no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: Knives were stored inaccessible in a locked drawer near the sink. Cleaning supplies, medications, and first aid kit were stored inaccessible and locked in cabinets to the right of the kitchen. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food and water within regulation. The LPA observed four (4) non-perishable food cans to be expired between May 2025 and August 2025. The Licensee stated the facility will review and update the non-perishables. Food in the two (2) refrigerators and freezers were observed to be properly stored. The kitchen contained laundry machines that were operational. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. Required postings were in the reception/office area located at the entrance of the facility. The facility maintained a comfortable temperature throughout the visit. Nightlights were observed throughout the facility and a hallway closet contained extra linens. BEDROOMS/RESTROOMS: There were nine (9) total bedrooms: seven (7) private resident rooms, one (1) staff room, and one (1) room utilized as storage. Bedroom #2 had a direct exit to the outside and the facility was approved for six (6) bedridden residents. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There were eight (8) total restrooms: one (1) visitor restroom and seven (7) private resident restrooms. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap, paper products, and displayed hand washing signs. Hot water was tested and measured between 115.7 degrees F and 118.6 degrees F, which was within the required range. At this time, the facility was in the process of making adjustments for a facility capacity increase request to twelve (12) residents. OUTDOOR AREA: The surrounding grounds had two (2) shaded patio areas equipped with furniture and a grilling area in good condition for residents and visitor use. There were three (3) remote driveway gates used for emergency exits with two pathways on both sides of the house that lead to both yards/driveways. The side pathways had three (3) self-latching gates. No bodies of water noted, and exits are free of obstructions. The LPA observed three (3) sheds in the backyard that contained general storage of facility supplies. Report Continued on LIC 809-C RECORDS: Record review began at 10:43AM. Resident records were reviewed for, but not limited to care plans, physician reports, admissions agreement, and 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. The LPA had a discussion with the Licensee to ensure staff are signing their training records to indicate they have received the required topics and hours. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 09/03/2025. Smoke and carbon monoxide detectors were tested at 10:14AM and were operational at the time of the visit. Fire extinguishers were observed throughout the facility and were last serviced on 04/15/2025. MEDICATIONS: Medication review began at 11:52AM. Medications are centrally stored and kept inaccessible in the kitchen cabinets. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates. Medications were properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Pursuant to Title 22 CA Code of Regulations, the following deficiency was cited (Refer to LIC 809-D). Exit interview conducted. A copy of the appeal rights and report were reviewed and provided.the state’s words, verbatim · CDSS document, Sep 4, 2025

Allegation investigated: Licensee is retaliating against residents authorized representative. Staff failed to assist resident with oral hygiene per physician orders. Licensee did not provide resident's authorized person copies of requested records.

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit to this facility to deliver findings. At 9:59 a.m., the LPA met with the Administrator, Angela Azniv Krbashyan and explained the reason for the visit. During the initial visit conducted on 8/4/2023 between 10:10 a.m. and 2:30 p.m., LPA Peraldi conducted a physical plant tour and conducted interviews with the Administrator, one (1) resident and one (1) staff. During the initial visit, the LPA reviewed records and obtained copies of pertinent documents. Continued on LIC 9099-C. Unsubstantiated Regarding the allegation: Licensee is retaliating against residents authorized representative. It was alleged that the Licensee is retaliating against Resident #1’s (R1’s) authorized representative by changing the Wifi password and not giving R1’s authorized representative the updated Wifi password. The Administrator stated that she does provide the Wifi password if requested. The LPA advised the Administrator and R1’s authorized representative that they need to communicate properly with one another without arguing. 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. Regarding the allegation: Staff failed to assist resident with oral hygiene per physician orders. It was alleged that staff did not follow R1’s oral hygiene per physician orders. Per record review conducted on 8/4/2023, R1 did not have a physician order for an oral hygiene routine. 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. Regarding the allegation: Licensee did not provide resident's authorized person copies of requested records. It was alleged that the Licensee did not provide R1’s authorized representative copies of R1’s records such as the needs and service plan. Interview conducted with the Administrator revealed that the Administrator provides copies of all resident records upon admission and as requested. The LPA received conflicting information throughout the course of the investigation. 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 provided.the state’s words, verbatim · CDSS document, Dec 31, 2024 · control 29-AS-20230802154022

Allegation investigated: Facility visiting hours are unreasonable.

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit to this facility to deliver findings. At 12:34 p.m., the LPA met with staff and explained the reason for the visit. At 12:58 p.m., the Administrator, Angela Azniv Krbashyan arrived at the facility. During the initial visit conducted on 06/27/2023 between 9:25 a.m. and 12:15 p.m., LPA Peraldi conducted interviews with the Administrator, two (2) staff and five (5) residents. The LPA also conducted a physical plant tour, reviewed records and obtained copies of pertinent documents. During the initial visit, the LPA also conducted interviews with a home health nurse and a physical therapist and a resident’s family member. Continued on LIC 9099-C. Substantiated Regarding the allegation: 1.) Facility visiting hours are unreasonable. On 06/22/2023, the Department received a complaint alleging that the facility’s visiting hours are unreasonable. During the initial visit, the LPA observed the facility’s visiting hours posted as Monday- Sunday 10 a.m. – 12:00 p.m. and 2:00 p.m. – 7:00 p.m. Interview conducted with the Administrator revealed that the visiting hours are not enforced, and families stay past 7:00 p.m. The Administrator explained that the gap between the visiting hours is for staff to take their lunches. The Administrator stated that she will change the visiting hours to more reasonable times such as 9:00 a.m. to 9:00 p.m. Based on observation and interviews, the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency were observed and cited during the visit (See 9099-D). Exit interview conducted. A copy of the report and appeal rights were provided. Regarding the allegations: 1.) Facility staff are not serving an adequate amount of food to residents. 2.) Facility does not provide a menu for residents in care. On 06/22/2023, the Department received a complaint alleging residents not being fed enough and not being provided a menu. During the initial visit, the LPA observed the kitchen with two (2) refrigerators with sufficient amount of perishable and nonperishable food. The LPA also observed a sample menu in the kitchen. Per 87555 General Food Service Requirements, “Facilities licensed for less than sixteen (16) residents shall maintain a sample menu in their file.” Interviews conducted with residents did not voice concerns regarding the food being served. Interview with the Administrator revealed that grocery shopping is done weekly or as needed. Additionally, the Administrator provided the LPA pictures of previous meals served to the residents. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed Unsubstantiated at this time. Regarding the allegation: 3.) Facility staff speaks in an aggressive tone towards a resident. On 06/22/2023, the Department received a complaint alleging staff speaking aggressively toward a resident. Resident interviews revealed that staff are kind and did not voice any concerns regarding staff. Staff interviews revealed that staff have not heard staff speak aggressively towards residents. Interviews conducted with home health nurse, physical therapist and resident’s family member did not reveal any concerns with staff and stated staff treat residents with respect. Interview with the Administrator denied staff speaking aggressively towards residents, however stated staff sometimes speak louder in order for some residents to hear since some residents are hard of hearing. 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 provided.the state’s words, verbatim · CDSS document, Nov 6, 2024 · control 29-AS-20230622091834

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Nov 15, 2024

87468.1 (a) (11) Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities for the elderly shall have all...:(11)To have their visitors ...permitted to visit privately during reasonable hours… This requirement has not been met as evidenced by: Based on interview and observations, the licensee did not comply with the section cited above as the visiting hours are unreasonable which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2024

Plan of correction: The Administrator already changed the visiting hours, plan of correction met.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility at approx.11:15 am to conduct an unannounced required annual visit. Upon arrival, LPA Mosley was greeted by staff and called the administrator to inform them of the visit. The administrator arrived shortly thereafter. The LPA met with Administrator AZNIV ANGELA KRBASHYAN and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Licensee is in the process of getting an increase in capacity to 12 and has already submitted information to the department for approval. LPA arrived and observed all six (6) residents eating lunch together followed by group discussion. Food menu matched the food that was served. BEDROOMS: The facility is a single-story residential home with nine (9) bedrooms, six (6) for resident's use and three (3) for staff. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: The facility has eight (8) restrooms, six (6) for resident use and two (2) for staff/ public use. Restrooms clean and sanitary and in operating condition with grab bars and non-skid mats. Starting at approx. 11:39 a.m., hot water measured between 105.7 and 112.6-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Continued on LIC 809-C. Report Continued from LIC 809C... KITCHEN: At approx. 11:48am the LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerators and food pantry were checked for proper labels and expiration dates. One (1) refrigerator is for staff use, one (1) is for facility use and a beverage refrigerator. The staff refrigerator has a locked medication box if needed, however it currently is not in use. Hot water measured at 105.1-degree Fahrenheit. Medications and first aid kits are in a locked cabinets near the kitchen area. First Aid supplies were checked at 11:55am, all supplies in order. Cleaning solutions, toxins, chemicals, and hazardous items were inaccessible and locked away in a cabinet near the kitchen area. The laundry units are located near the kitchen area. Emergency supplies including food and water are stored in one of the kitchen cabinets. COMMON AREAS: The LPA observed the common area to be clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 04/26/2024. At 1:56 p.m., fire alarms/ carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallway. The LPA observed an activities area near the dining room for resident use. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 6/15/24 and are conducted quarterly. Activities were observed in the common areas. OUTDOOR SPACE: At 12:12 p.m., the LPA observed the back patio and side patio which has a covered patio area with patio furniture including a table and chairs for resident use. The gates on the side and back of the house are self-latching and designated as emergency exits. All passageways were observed to be clear. There are three (3) storage units supplying extra bedding and nonchemical supplies. One (1) outdoor freezer with food for daily use. There are no bodies of water on the premises at the time of the visit. Continued on LIC 809-C. Report Continued from LIC 809C... RECORDS: Resident Records were reviewed beginning at 12:19 p.m. and personnel records at 1:00 p.m. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Five (5) personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. INTERVIEWS: Two (2) staff interviews were conducted. Six (6) client interviews were attempted, two (2) client interviews conducted and one (1) visitor / family member of a resident was interviewed during the inspection. MEDICATIONS: Medications review began at approximately 2:25 pm. The medications are locked in a cabinet in the kitchen. Medications for six clients were reviewed. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 3, 2024