Balboa Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct the required annual inspection. The LPA was greeted by staff. Staff contacted the Administrator and informed them of the visit. The Administrator Alla Harutunyan arrived shortly thereafter and the LPA explained the reason for the visit. The LPA and the Administrator 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. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was fully charged and was last serviced 005/29/2025. The LPA observed required postings by the foyer of the front door. The facility has a designated washer and dryer room which was observed to be locked at the time of the visit. KITCHEN: Knives and cleaning supplies are stored inaccessible to residents in care. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at 113.2 degrees Fahrenheit. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four (4) designated residents’ rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. Continues LIC809C... BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 113.2 degrees Fahrenheit. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water were noted. The facility has a detached garage, which at the time of the visit is being converted into an ADU. Once the ADU is completed the Administrator will request an additional fire inspection from the Los Angeles Fire Department (LAFD) to ensure that the facility continues to meet LAFD regulations as they pertain to the facility. The Administrator will add a ramp with rails to the front of the facility to provide access to the residents in care to the side of the facility’s additional outdoor shaded area, due to the construction of the ADU, which is restricting access to the previous designated outdoor shaded area. The Administrator will ensure that all staff and residents do not use as an exit room’s #3 and room’s # 1 backdoor to gain access to the side outdoor area. A fence will need to be added to the side outdoor area to prevent residents from gaining access to the ADU construction area. Once the ADU is completed, the Licensee will ensure that a fence is erected from the ADU wall to the side of the facility wall to ensure that ADU tenants do not have access to the facility. RECORDS: Records review began at 11:30 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 12:45 p.m.; medications are centrally stored and locked in a file cabinet in the dining room 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. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Emergency Drills - Liability Insurance Administrator will email the LPA once the ADU is completed and approved by the city, so that a follow up visit is conducted. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 26, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. The LPA met with the Administrator Alla Harutunyan, and explained the reason for the visit. The LPA and the Administrator 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. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was fully charged and was last serviced 03/21/2024. The LPA observed required postings throughout the common space. The facility has a designated washer and dryer room which was observed to be locked at the time of the visit. KITCHEN: Knives and cleaning supplies are stored inaccessible gto residents in care. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at 113.2 degrees Fahrenheit. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four (4) designated residents’ rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 113.2 degrees Fahrenheit. Continues LIC809C... OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water noted. The facility has a detached garage and it was observed to be locked at the time of the visit. RECORDS: Records review began at 12:30 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 file cabinet in the dining room 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 - Emergency Drills - Liability Insurance Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 21, 2025

Allegation investigated: Staff did not ensure that resident’s medication was refilled in a timely manner Unlawful eviction

Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit to the facility above to deliver final findings of the complaint allegations. At 12:15 P.M. LPA met with Alla Harutunyan, Administrator and explained the purpose of the visit. LPAs Conway and Dulek conducted the initial 10-day visit on 05/07/2024. During the visit, LPAs conducted a tour of the physical plant at 11:10 A.M. Additionally, LPAs conducted interviews with Administrator, residents and potential witnesses on 05/01/2024, 05/07/2024 and 11/15/2024 and obtained records pertinent to the investigation at 12:30 P.M. Continued on LIC 9099-C Substantiated Continued on LIC 9099-C Regarding allegation “Staff did not ensure that resident’s medication was refilled in a timely manner,” it was alleged that facility staff did not order Resident #1’s (R1) antibiotic Daptomycin medication timely. Information gathered during the course of the investigation reflected that Resident #1 (R1) was admitted to facility on 04/19/2024, following discharge from a medical center where they were treated for a bone infection. Upon admission, R1 had a Peripherally Inserted Central Catheter (PICC) and was prescribed the antibiotic Daptomycin, which was to be administered daily by an external Home Health (HH) nurse which continued until 4/25/2024. According to R1, on 04/25/2024, facility staff informed them that their supply of antibiotics was running low. However, when the HH nurse arrived the following day, 04/26/2024, to administer the antibiotic, it was discovered that the supply had run out. The HH nurse immediately advised the facility administrator, to transport R1 to the hospital to ensure they receive their daily dose. Records indicate that the facility logs prescribed medications for residents in care on the centrally stored medication and destruction record to log (LIC 622). However, Daptomycin was not recorded on R1’s LIC 622. Facility administrator stated that since the medication was administered by an external HH nurse rather than facility staff, it had not been recorded on the LIC 622. The facility has been storing the antibiotics for R1 but tracking the medication had not been documented because R1 was receiving HH services. Administrator further stated that R1’s family was expected to refill the antibiotic prescription accordingly and that the HH nurse had been informed about the low supply; however, administrator did not have any supportive documents to provide regarding this agreement. Administrator also could not provide LPAs with HH records pertaining to R1. Based on information gathered during the course of the investigation, there is sufficient evidence to determine that staff did not ensure that resident’s medication was refilled in a timely manner. Therefore, the above allegation “Staff did not ensure that resident’s medication was refilled in a timely manner” is deemed SUBSTANTIATED at this time. Continued on LIC 9099-C Continued on LIC 9099-C Regarding allegation unlawful eviction. It was alleged that administrator unlawfully evicted R1 by refusing to allow R1 to return to the facility after hospitalization. It was further reported that when R1’s family attempted to arrange R1’s return back to the facility on 04/29/2024, and they were informed that the facility could no longer meet R1’s needs. Information gathered during the course of the investigation reflected that R1 was admitted to the hospital due to the facility’s failure to obtained prescribed medication timely. However, when R1 was ready to be discharged from the hospital, the administrator informed that the facility could no longer accept the resident due to R1 needing a higher level of care. Therefore, R1 was left with no alternative place to go and was presented with only two options, being dropped off at the nearest homeless shelter or to seek accommodation with a family member. Additional information gathered, also reflected that staff did not conduct an initial pre-placement appraisal nor a reappraisal prior to hospital discharge before determining the resident needed a higher level of care. Moreover, R1 was also not issued a proper eviction notice. Based on information gathered during the course of the investigation, there is sufficient evidence to determine that R1 was unlawful evicted. Therefore, the above allegation “Unlawful eviction” is deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 23, 2024 · control 29-AS-20240429125818

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Dec 23, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(1) The licensee shall arrange, or assist in arranging...to the conditions and needs of residents. This requirement is not met as evidenced by… Based on interviews and records reviewed the licensee did not comply with the section cited above by not having a care plan prior to resident's arrival which poses an immediate health and safety rise for the residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2024

Plan of correction: Administrator will ensure that before admission, residents will have a pre-appraisal conducted and an evaluation of each resident's condition assessed. At this time no POC is due.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a)(4) · Plan of correction due date: Jan 6, 2025

87224(a)(4) Eviction Procedures (a)The licensee may evict a resident for one or more of the...Thirty (30) days written notice...(4)If, after admission, it is determined that the resident has a need not previously identified...This requirement is not met as evidenced by… Based on interviews and record review, the administrator did not ensure that they provided R1 and/or their responsible person with a proper eviction notice and did not get prior approval of eviction from licensing, which posed an immediate health and safety risk to resident(s) in care.the state’s words, verbatim · CDSS document, Dec 23, 2024

Plan of correction: Administrator will provide a statement of understanding regarging eviction process to LPA before POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Valeria Conway conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20240429125818). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation unrelated to the complaint. During today’s visit, LPA met with Alla Harutunyan and the reason for the visit was explained. During the course of the investigation, it was discovered that Resident #1(R1) was admitted to facility on 04/19/2024, following discharge from a medical center where they were treated for a bone infection and R1 had a Peripherally Inserted Central Catheter (PICC) and was prescribed the antibiotic Daptomycin, which was administered by a home health nurse. However, based on record review facility did not obtain an exception request from the Department prior to accepting/retaining R1 who had a prohibited health condition. Additionally, record review reflected that facility did not conduct a pre-placement appraisal, Needs and service plan, and home health admission folder/records prior to R1’s admission to the facility. Administrator stated that they did not consider it necessary to evaluate R1 because R1 was not an elderly person, and the hospital the resident was coming from was located far from the facility. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87506(a) · Plan of correction due date: Dec 27, 2024

87506(a) Resident Records a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidence by: Administrator did not comply with the above citation, as R1's records were not complete or current during complaint investigation which poses a potential health and safety risk to residents.the state’s words, verbatim · CDSS document, Dec 23, 2024

Plan of correction: Administrator agrees to write a statement of understanding on the importance of maintaning complete and current resident's records including a list of all required documents required before admission and submit them to LPA before POC due date

From the deficiency page — Deficiency type: Type A · Section cited: CCR87615(a)(4) · Plan of correction due date: Dec 27, 2024

87615(a)(4) Prohibited Health Conditions(a)Persons who require health services for or have a health condition including... (4)Staphylococcus aureus ("staph") infection or other serious infection.This requirement was not met as evidence by: Based on interviews and record review, the licensee did not comply with the section cited above when they retained a resident with prohibited health conditions, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 23, 2024

Plan of correction: Administrator agrees to write a statement of understanding regarding Prohibited Health Conditions, Also, a statement of understanding regarding on how to request an exemption from the department when need it. Administrator will submit them to LPA before due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual inspection. Upon arrival LPA met with Administrator Alla Harutunyan and explained the reason for the visit. At approximately 10:45am, 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. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher was fully charged and last serviced in June 09, 2023. The kitchen appeared to be clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable food stored in the fridge and non-perishable food properly stored. Kitchen knives are stored in a locked drawer in the center island of the kitchen. Stove burners are rendered inaccessible to the residents by installing a lock when not in use. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in the laundry area. This area was observed inaccessible to residents in care. No flies or other vermin were observed. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. Room # 5 is a designated staff room. All rooms were free of odors. All window screens were clean and maintained in good repair. Continued from 809 Common Areas: These included the living rooms and dining areas. The common areas were properly furnished and appeared to be relatively clean at this time. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The entire property is not fenced. The back and sides of the house are separated from the front yard by gates at the east and west side passageways. There is a gate on the driveway. There is a door w/gate with a self-latching mechanism for persons to enter the back yard. There are no other structures on the property. There are no bodies of water on the premises at the present time The garage is detached from the home and was inaccessible to resident. LPA observed the garage to store, Personal Protective Equipment, incontinent supplies, toiletries and other materials and equipment for facility use Records review began at 11:00am, five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Two (2) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were observed to be in order at this time. Last emergency / disaster drill was conducted on 01/15/2024. During today’s visit, LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of a communicable disease. The facility has not had a confirmed case of a communicable disease at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate at this time. Medications review began at approximately 1:30pm The medications are centrally stored in a locked cabinet in the dining area inaccessible to residents in care. Medications were observed to be properly documented on the centrally stored medications and destruction record at this time Continued from 809-C LPA interviewed three (3) residents and Administrator during the visit. LPA obtained the following documents - Census, Staff schedule, and Limited Liability insurance. Exit interview conducted and a copy of report was was providedthe state’s words, verbatim · CDSS document, Feb 16, 2024