SG Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:15 AM. LPA met with facility staff who contacted the facility Administrator Zaruhi Harutyunyan. The Administrator arrived to the facility at 10:27 AM Entrance interview conducted and the reason for the visit was explained. Beginning at 10:29 AM LPA along with the 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: 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 cabinet which contained knives and other sharp objects. LPA observed a secured under-sink cabinet which contained cleaning chemicals and pesticides. COMMON AREAS: This included the living/dining room and hallway. LPA observed the living/dining room to be clean and properly furnished at the time of the visit. The living room was observed to contain secured filing cabinets which contained facility files and resident medications, a television, and activities for resident use. LPA observed adequate seating for resident use. The hallway was observed to be clean and free from any obstructions. LPA observed a wall mounted fire extinguisher which was fully charged and purchased on 05/30/2026. Smoke detectors and carbon monoxide detectors were tested at 10:34 AM and were functional at the time of the visit. CONTINUED ON LIC 809C. BEDROOMS: There are three (3) bedrooms in the facility; all are designated for resident use, and all are designated as dual occupancy rooms. LPA and facility Administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom number one (1) is the approved bedridden room and contained a direct exit to the outside of the facility. Auditory alarms were observed to be functional on all facility exits. BATHROOMS: There are two (2) bathrooms at the facility. One (1) is designated as a resident restroom and one (1) is designated as a staff restroom. Both restrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in the resident shower and by the resident toilet, all were properly secured. The water temperature was measured between 109.4 and 112.1 degrees Fahrenheit, which is in compliance with regulation. OUTDOOR SPACE: The facility had one (1) emergency exit gate located at the front of the facility. LPA observed clear passageways for emergency exit use. The facility had adequate shaded outdoor seating for resident use. Cameras were observed on the outdoors of the facility. Five (5) sheds were observed to be properly secured. The sheds were observed to contain a washer and dryer, cleaning products, an adequate supply of emergency food and water, cleaning chemicals, household supplies, and additional care supplies. RECORD REVIEW: Record review began at 11:03 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. Six (6) staff files were reviewed. All staff files contained the required documents and trainings. Four (4) resident files were reviewed. All resident files reviewed contained all required documentation. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 12:24 PM. Medications for four (4) residents were observed. All medications reviewed were documented properly on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. CONTINUED ON LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, 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. The facility’s emergency disaster plan is up to date and is adequate. Both the facility’s emergency disaster plan and infection control plan are updated annually by the facility’s Administrator. The facility’s last emergency disaster drill was conducted on 06/26/2026. INTERVIEWS: LPA interviewed one (1) staff and one (1) resident. The resident interviewed stated that facility staff treat them well and are attentive to their needs. The staff member interviewed was knowledgeable on their roles and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s updated LIC 500, resident roster, liability insurance, and emergency disaster plan. No deficiencies were observed during today’s visit. Exit interview conducted. And a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 10, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:12 AM. LPA met with facility staff who contacted the facility Administrator Zaruhi Harutyunyan. The Administrator arrived to the facility at 10:33 AM Entrance interview conducted and the reason for the visit was explained. Beginning at 10:33 AM LPA along with the 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: 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 cabinet contain knives and other sharp objects. LPA observed a secured under-sink cabinet to contain cleaning chemicals that were locked and inaccessible to clients in care. BEDROOMS: There are three (3) bedrooms in the facility; all are designated for resident use, and all are designated as dual occupancy rooms. LPA and facility Administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom number one (1) is the approved bedridden room and contains a direct exit to the outside of the facility. Auditory alarms were observed to be functional on all exits. Continued on LIC 809C. BATHROOMS: There are two (2) bathrooms at the facility. One (1) is designated as a resident restroom and one (1) is designated as a staff restroom. Both restrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in the resident shower and by the resident toilet, all were properly secured. The water temperature was measured between 109.8 and 112.0 degrees Fahrenheit, which is in compliance with regulation. COMMON AREAS: This includes the living room and hallway. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room was observed to contain secured filing cabinets which contained facility files and resident medications, a television, and activities for resident use. LPA observed adequate seating for resident use. The hallway was observed to be clean and free from any obstructions. Required postings were observed throughout the facility. LPA observed a wall mounted fire extinguisher to be fully charged and purchased on 05/10/2025. Smoke detectors and carbon monoxide detectors were tested at 11:20 AM and were functional at the time of the visit. OUTDOOR SPACE: The facility has one (1) emergency exit gate located at the front of the facility. LPA observed clear passageways for emergency exit use. The facility has adequate shaded outdoor seating for resident use. Cameras were observed on the outdoors of the facility. Five (5) sheds were observed to be properly secured. The sheds were observed to contain a washer and dryer, cleaning products, an adequate supply of emergency food and water, cleaning chemicals, and additional care supplies. RECORD REVIEW: Record review began at 11:15 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. All resident files reviewed contained all required documentation. No deficiencies were observed during record review. MEDICATION REVIEW: Medication review began at 12:05 PM. Medications for three (3) residents were observed. All medications reviewed were documented properly on their respective centrally stored medication and destruction record sheet. No deficiencies were observed during medication review. Continued on LIC 809C. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, 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. The facility’s emergency disaster plan is up to date and is adequate. Both the facility’s emergency disaster plan and infection control plan are updated annually by the facility’s Administrator. The facility’s last emergency disaster drill was conducted on 06/26/2025. INTERVIEWS: LPA interviewed one (1) staff and two (2) residents. All residents interviewed stated that facility staff treat them well and are attentive to their needs. No residents interviewed had concerns with the facility. The staff member interviewed was knowledgeable on their roles and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s updated LIC 500, resident roster, and liability insurance. No deficiencies were observed during today’s visit. Exit interview conducted. And a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 11, 2025

Allegation investigated: Staff are not ensuring that resident's hygiene needs are being met. Staff are not repositioning resident as necessary. Staff are not ensuring that resident is being fed in a safe manner. Staff are not ensuring that resident has clean bedding. Staff handle resident in a rough manner.

Licensing Program Analysts (LPAs) Emily Peraldi and Trevor Byrne conducted an unannounced subsequent complaint visit to this facility. At 9:35 a.m., the LPAs met with staff and explained the reason for the visit. At 9:36 a.m., the Administrator, Zaruhi Harutyunyan arrived at the facility. During today’s visit, between 9:37 a.m. and 10:48 a.m., the LPAs conducted a physical plant tour, a record review and interviewed the Administrator, one (1) staff and five (5) residents. During the initial visit, on 03/27/2023 between 1:53 p.m. and 3:00 p.m., LPA Camara conducted a physical plant tour, reviewed records, conducted an interview with one (1) resident and the Administrator and conducted a phone interview with a witness. Continued on LIC 9099-C. Unsubstantiated Regarding the allegations: 1.) Staff are not ensuring that resident's hygiene needs are being met. The Department received a complaint on 03/22/2023 alleging that staff do not properly clean Resident #1 (R1). During the physical plant tours on 03/27/2023 and 08/21/2024, LPAs observed residents to be well groomed. Interviews with residents did not reveal any concerns with staff not meeting their hygiene needs. Interviews with staff and Administrator revealed that residents get bathed twice a week. Additionally interview with R1’s family member did not have any concerns regarding R1’s care and hygiene needs. 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 allegations: 2.) Staff are not turning resident as necessary. The Department received a complaint on 03/22/2023 alleging that staff do not reposition Resident #1 (R1). Interviews with residents revealed that staff do reposition residents throughout the day. Interview with staff and Administrator revealed that staff reposition residents every two hours or as needed. 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 allegations: 3.) Staff are not ensuring that resident is being fed in a safe manner. The Department received a complaint on 03/22/2023 alleging that staff do not ensure Resident #1 (R1) is positioned properly before eating to prevent any choking. Interviews with the Administrator revealed that staff do supervise R1 and other residents while eating. The Administrator stated that R1 and other residents can feed themselves, however, do require supervision for their safety. No concerns were brought up during resident interviews regarding supervision during meals. 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. Contiued on LIC 9099-C. Regarding the allegations: 4.) Staff are not ensuring that resident has clean bedding. The Department received a complaint on 03/22/2023 alleging that staff do not ensure Resident #1’s (R1’s) sheets are changed and cleaned. During the physical plant tours on 03/27/2023 and 08/21/2024, LPAs observed all residents’ beds with clean linens. Interviews with residents revealed that staff and clean change their linens daily and weekly. Staff interviews revealed that staff change linens as need which could be daily. 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 allegations: 5.) Staff handle resident in a rough manner. The Department received a complaint on 03/22/2023 alleging that Staff #1 (S1) handled Resident #1 (R1) in a rough manner. Interviews with residents, including R1 revealed that staff including S1 are very gently with residents and had no complaints regarding staff. Additionally interview with R1’s family member did not have any concerns regarding R1’s care or staff. 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, Aug 21, 2024 · control 29-AS-20230322095137

Allegation investigated: Staff left resident in soiled diapers for an extended period of time. Staff does not meet the needs of resident in a timely manner. Staff did not provide adequate food service to resident in care. Staff does not assist resident with transfers to wheelchair. Staff are unable to communicate with resident due to language barrier.

Licensing Program Analysts (LPAs) Emily Peraldi and Trevor Byrne conducted an unannounced subsequent complaint visit to this facility. At 9:35 a.m., the LPAs met with staff and explained the reason for the visit. At 9:36 a.m., Administrator Zaruhi Harutyunyan, arrived at the facility. During today’s visit, between 9:37 a.m. and 10:48 a.m., the LPAs conducted a physical plant tour, a record review and interviewed the Administrator, one (1) staff and five (5) residents. During the initial visit, on 05/02/2024 between 12:50 p.m. and 2:20 p.m., LPA Peraldi conducted a physical plant tour, conducted interviews with three (3) residents and one (1) staff, the Administrator and with a resident’s family member. During the initial visit, the LPA also requested and obtained copies of pertinent documents. Continued on LIC 9099-C. Unsubstantiated Regarding the allegations: 1.) Staff left resident in soiled diapers for an extended period of time. 2.) Staff does not meet the needs of resident in a timely manner. The Department received a complaint on 04/30/2024 alleging that staff did not change R1’s diaper in a timely manner leaving R1 in a soiled diaper for an extended period of time. During the physical plant tours on 05/02/2024 and 08/21/2024, LPAs did not observe any foul odors that may have indicated soiled diapers. LPAs observed pendants for each resident. Residents ring their pendant when they need to use the bathroom or if they need a diaper change. Interviews with staff and the Administrator revealed that staff change residents’ diapers 3 times a day or as needed. Interviews with residents reveal that staff do change their diapers as needed and do not leave residents with soiled diapers. Resident interviews revealed that staff do assist residents in a timely manner. Additionally interview with R1’s family member did not have any concerns regarding R1’s care. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegation 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.) Staff did not provide adequate food service to resident in care. The Department received a complaint on 04/30/2024 alleging that Resident #1 (R1) was served cold soup. During the physical plant tours on 05/02/2024 and 08/21/2024, LPAs observed sufficient amount of perishable and nonperishable food. Interviews conducted with residents revealed that residents had no complaints regarding the food and stated that they enjoyed the food that is served. Interviews with staff revealed that staff cook food that residents prefer. Staff stated that they always include fruits, vegetables, and protein for each meal and or snacks. Administrator provided photos of various meals served to residents to the LPAs. Additionally interview with R1’s family member did not have any concerns regarding R1’s food service. 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. Continued on LIC 9099-C. Regarding the allegation: 4.) Staff does not assist resident with transfers to wheelchair. The Department received a complaint on 04/30/2024 alleging that Resident #1 (R1) does not receive assistance with transfers to wheelchair. Interviews with residents revealed that staff do assist residents with transfers to wheelchair. Resident interviews revealed that staff assist with transfers to wheelchair daily or when requested. Interviews with staff revealed that residents get transferred to their wheelchairs for their meals, outdoor time and when residents request to do be on their wheelchairs. Additionally interview with R1’s family member did not have any concerns regarding R1’s care. 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: 5.) Staff are unable to communicate with resident due to language barrier. The Department received a complaint on 04/30/2024 alleging that Staff #1 (S1) is unable to communicate with residents since S1’s primary language is not English. Interviews with residents revealed that staff, including S1, are able to properly communicate with residents and if there are issues, staff and S1 call the Administrator for assistance. Resident interviews did not reveal any concerns with staff and S1’s communication. The information obtained during the investigation did not include sufficient evidence 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, Aug 21, 2024 · control 29-AS-20240430154047

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Trevor Byrne and Emily Peraldi arrived at the facility unannounced to conduct a required annual visit at 09:35 AM. LPAs met with facility staff who contacted the facility administrator Zaruhi Harutyunyan. Facility administrator arrived to the facility at 09:36 AM Entrance interview conducted and the reason for the visit was explained. Beginning at 09:37 AM, the LPAs, 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 LPAs observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPAs observed a secured cabinet contain knives and other sharp objects. The LPAs observed the fire extinguisher to be fully charged and purchased on 06/12/2024. BEDROOMS: There are three (3) bedrooms in the facility; all are designated for resident use, and all are designated as dual occupancy rooms. LPAs and facility administrator toured all three (3) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom number one (1) is approved for a bedridden resident. Auditory alarms were observed to be functional on bedroom one’s (1’s) exit door. BATHROOMS: There are two (2) bathrooms at the facility. One (1) is designated as a resident restroom and one (1) is primarily used as a staff restroom. Both restrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in the resident restroom shower and by the resident toilet, all were properly secured. The water temperature was measured between 110.1 and 113 degrees Fahrenheit, which is in compliance with regulation. Report Continued on LIC 809-C Continued from LIC 809-C COMMON AREAS: This includes the living room. LPAs observed the living room to be clean and properly furnished at the time of the visit. Smoke detectors and carbon monoxide detectors were tested at 10:00 a.m. and were functional at the time of the visit. OUTDOOR SPACE: The facility has one (1) emergency exit gate, LPAs observed clear passageways for emergency exit use. The facility has adequate seating for resident use. Cameras were observed by the front entrance to the facility. Five (5) sheds were observed to be properly secured, one (1) contained a washer and dryer as well as cleaning products. One (1) shed contained an adequate supply of emergency food and water. The remaining three (3) sheds contained additional supplies and cleaning chemicals. RECORD REVIEW: Record review began at 10:05 a.m. 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, TB tests, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documents and trainings. Six (6) resident files were reviewed. All resident files reviewed contained all required documentation. No deficiencies were observed during record review. MEDICATION REVIEW: Medications are stored centrally and securely in a filing cabinet located in the living room. Medications for three (3) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet. No deficiencies were observed during medication review. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPAs 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. Last emergency disaster drill was conducted 06/26/2024. The facility’s emergency disaster plan is up to date and adequate. Report Continued on LIC 809-C Continued from LIC 809-C INTERVIEWS: LPAs interviewed one (1) staff and five (5) residents. All residents interviewed stated that the food was of good quality and is provided in sufficient amounts. All residents stated that staff treat them well and are attentive to their needs. The staff member interviewed was knowledgeable on their roles and responsibilities, resident rights, the different forms of abuse and the appropriate reporting procedures for suspected abuse. During today’s visit LPAs obtained a copy of the facility’s updated LIC500, resident roster, and liability insurance. No deficiencies were cited at the time of the visit. Exit interview conducted. And a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 21, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.