Laurelgrove Board and 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 09:28 AM. LPA met with facility staff who contacted the facility Administrator Dianna Karapetyan. The Administrator arrived to the facility at 09:43 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 09:45 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: OUTDOOR SPACE: The facility had one (1) 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 a locked storage shed which contained tools and extra care supplies. The backyard was observed to contain an appropriately fenced pool that was empty of all water at the time of the visit. One (1) extra refrigerator was observed in the backyard of the facility. At 09:49 AM LPA observed an unsecured hand saw in the back yard near the storage shed. LPA informed the Administrator who immediately secured the item in locked storage. BEDROOMS: There are five (5) bedrooms in the facility; one (1) is a dual occupancy room and four (4) are single occupancy rooms. LPA and facility Administrator toured all five (5) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on facility exits and all were functional at the time of the visit. Bedrooms #1 & 2 contain direct exits to the outdoors of the facility. Continued on LIC 809C. BATHROOMS: There are four (4) resident bathrooms at the facility and one (1) staff bathroom. Three (3) bathrooms are designated as private resident bathrooms, one (1) bathroom is designated as a shared resident bathroom. All 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 111.9 and 113.7 degrees Fahrenheit, which is within the range required by regulation. 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. LPA observed a secured under sink cabinet which contained cleaning chemicals. LPA observed a fire extinguisher mounted in the kitchen to be fully charged and serviced on 01/05/2025. COMMON AREAS: This included the living room, hallway, and dining area. LPA observed the dining room to be clean and properly furnished at the time of the visit. The living room was observed to contain activities for resident use including a television. The dining area contained a dining table with adequate seating for resident use. LPA observed a locked hallway closet to contain resident medications and facility files. All furniture throughout the facility was observed to be relatively clean and in good repair. The facility’s combination fire and carbon monoxide alarms were tested at 10:37 AM and were functional at the time of the visit. LPA observed an ADU on the property that was not present at the last annual visit. On 05/12/2025 Community Care Licensing Division (CCLD) was notified of proposed construction at the facility. On 05/12/2025 LPA requested documentation pertaining to the proposed construction including an updated facility sketch. LPA reviewed documentation submitted to CCLD by the Administrator and did not observe an updated facility sketch. LPA informed the Administrator that an updated sketch was requested by CCLD but was not received. The Administrator agreed to send an updated facility sketch to CCLD. Additionally, LPA informed the Administrator that due to the layout of the newly constructed ADU tenants of the ADU share common outdoor areas with facility residents. LPA informed the Administrator that because tenants of the ADU have access to the facility, any future tenants in the ADU will be required to obtain finger print clearance and have association to the facility. LPA informed the Administrator that failure to comply could result in the issuance of civil penalties. The Administrator expressed understanding and agreed to comply with the requirements. Continued on LIC 809C. RECORD REVIEW: Record review began at 10:50 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. Five (5) staff files were reviewed. Staff #1 (S1) was observed to be hired on 12/15/2025. During the visit LPA observed S1 to be providing assistance to residents with activities of daily living (ADLs). LPA reviewed S1’s file and did not observe trainings on file. LPA asked the Administrator why trainings were not in S1’s file and the Administrator informed LPA that some trainings had been completed but since S1 was new no documentation had been created. LPA informed the Administrator that staff members shall complete twenty (20) hours of training, including six (6) hours specific to dementia care and four (4) hours specific to postural supports, restricted health conditions, and hospice care, before working independently with residents. The Administrator expressed understanding and agreed to complete the required trainings with S1. Six (6) resident files were reviewed. Resident #1’s (R1) file was observed to contain an admission agreement for a different facility. LPA informed the Administrator who stated that R1 was transferred to this facility but no new admission agreement was created because both facilities are run under the same Operator. LPA informed the Administrator that admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, and the licensee or the licensee’s designated representative no later than seven (7) days following admission. The Administrator expressed understanding and agreed to complete an admission agreement for R1. MEDICATION REVIEW: Medication review began at 11:45 AM. Medications for three (3) of six (6) 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. 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 to be conducted quarterly the Administrator was unable to provide LPA with documentation that showed the facility’s last emergency disaster drill. 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. Continued on LIC 809C. INTERVIEWS: LPA interviewed three (3) residents and two (2) staff members. All three (3) residents interviewed had concerns relating to the variety of food served at the facility. LPA informed the Administrator of the concerns regarding the variety of foods offered for meals. The Administrator agreed to implement a more robust and varied menu for the dinner service at the facility. One (1) staff interview was conducted with the assistance of the facility Administrator acting as a translator. Both staff members interviewed understood their roles and responsibilities, 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-Ds): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 23, 2025

Allegation investigated: Staff financially abused a resident in care

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced follow-up complaint investigation visit at the facility at 03:03 PM. LPA met with facility staff who contacted the Administrator Dianna Karapetyan. The Administrator arrived to the facility at approximately 03:20 PM the reason for the visit was explained and entrance interview was conducted. During the initial complaint visit on 01/22/2025, LPA conducted a physical plant tour to ensure there are no health and safety hazards, collected copies of pertinent documents, and conducted interviews with the Administrator, one (1) staff member, and three (3) residents between 09:30 AM. and 11:20 AM. During the follow-up visit on 02/07/2025, LPA conducted a brief physical plant tour, Interviewed one (1) staff member, two (2) witnesses, and one (1) resident. During today’s visit LPA interviewed the Administrator and delivered findings for two (2) allegations. Substantiated The allegation of “Staff financially abused a resident in care” alleges that facility staff did not safeguard R1’s monetary resources while their "Golden State Advantage" Food stamps card was in staff’s possession. During an interview with R1 they revealed that they had a food stamps card that they would give to staff to purchase additional food items. R1 stated that they gave the card to facility staff in November of 2024 but did not receive the card back until late December 2024. R1 stated that they made no requests for food purchases during the timeframe that the card was not in their possession. LPA was provided with a receipt from Food 4 Less which showed the remaining balance on the card to be $206.16. R1 confirmed that when they received the card back there was $0 left on the card. Conformation was received via telephone call that the balance left on the card was $0. LPA interviewed facility staff who confirmed that R1 did not order any extra food items between November and December. Facility staff denied spending any of the money on R1’s card. Facility staff believed that R1’s card was subject to a scam. Facility staff confirmed that they were in possession of R1’s card during the timeframe of November to December. Facility staff confirmed that the money went missing off of R1’s card during the timeframe that they were in possession of the card. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Staff financially abused a resident in care“ Therefore, the allegation is deemed Substantiated at this time. The following deficiency was cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted. The allegation of “Staff physically abused a resident in care” alleges that facility staff #1 (S1) hit Resident #1 (R1) on the shoulder three (3) times during an altercation. During the initial interview with R1 they stated that during the altercation with S1 they were struck in the shoulder three (3) times. R1 also stated that these strikes caused them to suffer a scratch on their nose. LPA did not observe any injuries or scaring to R1’s nose at the time of the interview. R1 stated that they never sought medical attention for the injuries they sustained and never reported the incident to other facility staff. During a follow-up interview with R1 they stated that the injuries they sustained were actually scratches on their hand and not their nose. LPA interviewed S1 who denied ever striking or scratching R1. S1 provided LPA with a photograph of injuries they sustained to their hand. S1 stated that while they were holding on to R1’s bag, R1 scratched their hands breaking the skin. S1 along with other facility staff members confirmed that the photo provided to LPA was a picture of S1’s hand not R1’s. Interviews with Resident #2 (R2) and Resident #3 (R3) did not reveal any concerns with staff members. Both residents denied ever witnessing confrontations between staff and residents. Based on the information obtained, there is insufficient evidence to support the allegation. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff physically abused a resident in care.” Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview was conducted. This report was reviewed with the Administrator and a copy was provided.the state’s words, verbatim · CDSS document, Apr 3, 2025 · control 29-AS-20250117154733

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Apr 17, 2025

87217 Safeguards for Resident Cash, Personal Property, and Valuables (b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables... This requirement is not met as evidenced by: Based on interviews and record review the licensee did not comply with the section cited above as $206.16 went missing from R1's EBT card while the card was in posession of the facility which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Apr 3, 2025

Plan of correction: Licensee will submit their plan on how they will resolve R1's missing money to CCLD no later than POC due date.

Allegation investigated: Staff did not safeguard a resident's personal belongings Staff refused a resident access to the facility's telephone Staff did not ensure food the resident was eating was safe for consumption

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced follow-up complaint investigation visit at the facility at 01:57 PM. LPA met with facility staff who contacted the Administrator Dianna Karapetyan. The Administrator arrived to the facility at approximately 02:10 PM the reason for the visit was explained and entrance interview was conducted. During the initial complaint visit on 01/22/2025 LPA conducted a physical plant tour to ensure there are no health and safety hazards, collected copies of pertinent documents, and conducted interviews with the Administrator, one (1) staff member, and three (3) residents between 09:30 AM. and 11:20 AM. During today’s visit LPA conducted a brief physical plant tour, Interviewed one (1) staff member, two (2) witnesses, and one (1) resident. Continued on LIC 9099C. Unsubstantiated The allegation of “Staff did not safeguard a resident's personal belongings” alleges that facility staff took three (3) packages of cigarettes from resident #1’s (R1) possession. An interview with R1 revealed that they had a bag containing 10 packages of Lucky Strike Cigarettes. R1 stated that Staff #1 (S1) had taken the bag containing the packages of cigarettes from their possession. R1 stated that that facility staff returned the bag the same evening but the bag only contained seven (7) packages of cigarettes upon receipt. Interviews with facility staff members and other facility residents revealed that no other members of the facility are smokers. No other residents interviewed have had personal items taken by staff and no residents interviewed have been denied access to their personal belongings. S1 denied taking any packages of cigarettes from R1’s bag. LPA confirmed with staff and R1 that due to the care needs of the other residents residing at the facility cigarettes would need to be stored inaccessible to the other residents in care. CCR 87309(c) states, “Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents.” Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not safeguard a resident's personal belongings.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff refused a resident access to the facility's telephone” alleges that facility staff denied R1 access to the facility’s telephone during the evening that R1’s cigarette bag was taken from them. During an interview with Witness #1 (W1) they initially stated that they remembered the evening where R1 had their cigarettes taken. W1 initially informed LPA that they recalled speaking with R1 that evening and described R1 as “Hysterical” W1 stated that R1 was upset that they couldn’t go outside to smoke. Interviews with other residents of the facility did not reveal any concerns regarding access to the facility phone. All staff interviewed denied ever forbidding residents access to the facility’s phone. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff refused a resident access to the facility's telephone.” Therefore, the allegation is deemed Unsubstantiated at this time. Continued on LIC 9099C. The allegation of “Staff did not ensure food the resident was eating was safe for consumption” alleges that the facility is poisoning R1 with arsenic laced food. During the physical plant tour LPA observed the facility’s refrigerators and freezers to be maintained at appropriate temperatures. LPA did not observe any chemicals stored in food preparation areas. LPA did not observe any poisons located on the facility’s premises. Interviews with other residents did not reveal any concerns with the quality of the food being served at the facility. All staff members interviewed denied adding harmful substances to any resident’s food. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not ensure food the resident was eating was safe for consumption.” Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview was conducted. This report was reviewed with the Administrator and a copy was provided.the state’s words, verbatim · CDSS document, Feb 7, 2025 · control 29-AS-20250117154733

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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 09:14 AM. LPA met with facility staff who contacted the facility administrator Dianna Karapetyan. The administrator arrived to the facility at approximately 09:35 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at approximately 09:35 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. LPA observed a secured under sink cabinet to contain cleaning chemicals. LPA observed adequate emergency food and water supplies stored in a kitchen cabinet. LPA observed a fire extinguisher mounted in the kitchen to be fully charged and purchased on 01/25/2025. LPA observed the refrigerator to contain unsecured vitamins belonging to a facility staff member. BEDROOMS: There are four (4) bedrooms in the facility; two (2) are dual occupancy rooms and two (2) are single occupancy rooms. LPA and facility administrator toured all four (4) resident rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Auditory alarms were observed on facility exits and all were functional at the time of the visit. Continued on LIC 809C. BATHROOMS: There are four (4) bathrooms at the facility. Two (2) bathrooms are designated as private resident bathrooms, one (1) bathroom is designated as a shared resident bathroom and one (1) bathroom is designated as a staff bathroom. All 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 122.4 and 134.8 degrees Fahrenheit, which is outside the range required by regulation. One (1) private resident bathroom was observed to contain a broken mirror. OUTDOOR SPACE: The facility has one (1) emergency exit gate 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 a locked storage shed to contain wheelchairs, tools, chemicals, and extra care supplies. The backyard was observed to contain an appropriately fenced pool that was empty of all water at the time of the visit. One (1) extra refrigerator was observed in the backyard of the facility. The back patio outside of bedroom #2 is the designated smoking area of the facility. COMMON AREAS: This includes the living room, hallway, storage room, and dining room. LPA observed the dining room to be clean and properly furnished at the time of the visit. The dining room contains a dining table with adequate seating for resident use. The living room was observed to be clean and in good repair. The living room was observed to contain a television and activities for resident use. LPA observed a locked hallway closet to contain resident medications and facility files. The facility’s combination fire and carbon monoxide alarms were tested at 12:19 PM and were functional at the time of the visit. RECORD REVIEW: Record review began at 10:30 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. Six (6) resident files were reviewed all resident files contained all required documentation and signatures. No deficiencies were observed during record review. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at 11:45 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. 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 01/09/2025. 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 three (3) residents and two (2) staff members. Two (2) of the residents interviewed stated that the staff treat them well and are attentive to their needs. Two (2) residents had no concerns with the facility. Both staff interviews were conducted with the assistance of the facility administrator acting as a translator. Both staff interviewed understood their roles and responsibilities, 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-Ds): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Jan 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Sandra Urena arrived at the facility unannounced to conduct an annual inspection. The LPA was greeted by staff and called the Administrator Lusine Tadevosyan. The LPA communicated with the administrator and stated that they were not available, and the staff designated by the facility would arrive shortly. The staff Anahit Ohanyan arrived shortly thereafter, and the LPA and explained the reason for the visit. The LPA, and the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and that the facility is in compliance with Title 22 Regulations. KITCHEN: A seven-day supply of non-perishable food was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. House cleaning supplies will be stored and locked in the cabinet under the sink. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. There is a television in the living room area. The facility’s smoke/carbon monoxide alarm systems are hard wired. All rooms were tested, and all smoke/carbon monoxide alarm systems were in operating condition. A fire extinguisher is properly charged, and is located near the main door entrance, and mounted on the wall in the kitchen area. The fire extinguisher was last purchased on 01/10/204. The laundry area room is located outside. The supply of linens is sufficient to permit changing weekly or more often as needed to ensure use of linens at all times. Required posters are posted in the dining room area. BEDROOMS: Facility has five (5) bedrooms for resident use. There is no bedroom available for staff use. Bedrooms 2, 3, 4 and 5 are for single occupancy. Bedroom #1 is designated as a shared bedroom. Either bedroom #1, or #2 are approved for one (1) bedridden resident. Lighting in the rooms appeared adequate. All bedrooms had adequate closet and drawer space for clothing, and personal belongings. Continues on LIC809C ... BATHROOMS: The facility has four bathrooms. Bathrooms are private, located inside the bedrooms and are for residents’ use, are fully stocked with paper towels, and liquid hand soap. The showers have non-skid surface mats. Hot water temperatures were recorded in Fahrenheit degrees as follows:109.2 degrees for bathroom in bedroom #1, 110.2 degrees for bathroom in bedroom #2, 115.5 degrees in bathroom for bedrooms #4 and #5, and 116.2 degrees for bedroom #3. Hand washing signs were visible and posted. The bathroom designated for staff use, is located outdoors inside the laundry room. OUTDOOR: The exterior passageways were clean, and clear of any obstructions. The front patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. Fire emergency gates are clear of obstructions. The facility has a gated pool with a locked padlock and is inaccessible to residents. RECORDS: Records review began at 12:09 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 in the kitchen area; 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, Jan 13, 2024