Prestige Residential Care Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection using the CARE Inspection Tool and was let into the home by Eleanora Gabrielyan, Staff. Staff contacted Nelli Sadoyan, Administrator, by telephone and she arrived to conduct the visit at 10:27am. The reason for today's visit was provided. The facility is a single storey family home consisting of a living room, dining room, kitchen, 3 resident bedrooms, an office, 2.5 bathrooms and a detached garage. The facility is fire cleared for 2 AMBULATORY, 2 NON-AMBULATORY and 1 BEDRIDDEN resident. The facility has an approved hospice waiver for 5. On today's visit, all 12 domains of the CARE Inspection Tool, 5 resident files and 3 staff files were reviewed. A tour of the entire facility, inside and outside, was conducted. The following was observed: the living room, dining room and kitchen were all furnished and equipped with the appropriate furniture and equipment for its designated use. The fire place in the living room was sealed with a fire screen. Bedroom #1 is a single room and Bedroom #2 and Bedroom #3 are shared rooms. All bedrooms were furnished with a bed, a night stand, a lamp, a dresser, a chair and a built in closet in bedroom #1 and bedroom #3. Bedroom #2 has portable closet. Bed linens were observed in the hallway and towels in the common bathroom closet. The common bathroom is equipped with tub, a toilet, shower chair and a sink. The water temperature tested 100.1 degrees Fahrenheit. The private bathroom inside bedroom #2 is equipped with a walk in shower, a toilet and a sink and a shower chair. The water tested 101.4 degrees Fahrenheit. The back bathroom just has a walk in shower with a shower chair. All 3 bathrooms have grab baths and slip Page 2. resistant mats. The hardwired smoke detectors located in the resident bedrooms, living rooms, hallway and the only combination smoke/carbon monoxide detector located in the hallway located by bedroom #3 were all tested and were operational. The auditory device located on the front door and the back door located in bedroom #2 were operational. The first aid kit was reviewed and contained a scissors, tweezer and a thermometer. A first aid manual was also observed. The facility has current general liability insurance that meets Title 22 requirements. The food was reviewed and sufficient perishable foods for a minimum of 2 days and insufficient non-perishable foods for a minimum of 7 days was observed. The facility has purchased 2 emergency food kits for non-perishable foods. The only fire extinguisher located in the dining room was purchased on 2/5/25 and was observed to be full. The front yard was observed with an umbrella and chairs for activities. The enclosed back yard was observed to be clean. Per review of the files, Staff have current First aid training. The Administrator and the house manager do not have current CPR training, Eleonora Gabrielyan, Staff has current CPR training and was present at the facility. LPA Yee will clarify the fire rated door installed in the resident hallway and will address any deficiencies related to the doors on a return visit if needed. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Any deficiencies not addressed on today's visit will be addressed on a return visit. Exit interview was conducted, Appeal Rights were discussed and a copy was provided.the state’s words, verbatim · CDSS document, Feb 12, 2026

The state marks this report as 10 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a required annual visit at 10:15 A.M. LPA met with facility Administrator Nelly Sadoyan and discussed the reason for today's visit. At 10:45 A.M. House Manager, Hrant Narinyan joined the visit. Entrance interview conducted. At 10:30 A.M., LPA, along with 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. The following was observed: Fire Extinguisher was observed to be fully charged and purchased during today’s visit. Hardwired combination smoke detectors and carbon monoxide detectors were tested at 12:52 P.M. and were functional at the time of the visit. COMMON SPACES: In the common areas, including dining room and living room, walls and flooring were checked for cleanliness and good condition. At the time of the visit, furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which was adequately screened. Auditorial signal was observed to be in working conditions at the time of the visit. Facility has three fire doors to contain a fire from one side of the house to the other side. At the time and during the visit, LPA observed two (2) doors kept open by a chair in room number #2 and by a walker in room #3. These items prevent fire door from closing and violates fire codes. During today’s visit administrator removed items and fire doors were closed. LPA observed a ring doorbell, administrator did not know that a waiver is required to have ring doorbell. LPA did not cite but advised the licensee to submit a waiver for the Ring doorbell due to the audio component, to update plan of operation and admission agreement. Continued on LIC 9099-C Continued from LIC-9099 BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, and sufficient lighting. There are three (3) total bedrooms. Two (2) shared rooms and one (1) private room. BATHROOMS: The LPA observed 2 shared bathrooms and one shower room equipped with just a shower stall. Grab bars, slip-resistant mat and a shower chairs were observed. Resident restrooms are clean and sanitary. Between 10:31 A.M. and 10:47 A.M. hot water temperature was measured in all residents’ bathrooms, however, measurements were above the required range of 105 degrees Fahrenheit to 120 degrees Fahrenheit at the time of the visit. During today’s visit administrator lower the temperature gage on the main water tank to maintain a range of 105-120 degree F. LPA observed cleaning supplies and disinfectants inside a locked cabinet under the sink in hallway bathroom. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency supply. LPA conducted a review of expiration dates on product labels. LPA observed locked medication inside the refrigerator. All knives and sharps were observed to be locked and properly stored at the time of the visit. At 10:50 A.M. hot water temperature measured at 139.5 degrees Fahrenheit. Cleaning compounds were and separately from food supplies. OUTDOOR SPACE: The front yard area includes a gazebo furnished with a table and chairs for resident use. At the time of the visit LPA observed that the cover, which is design to provide shade for individuals seated beneath the gazebo, was missing. The administrator stated that the cover had been torn off by the wind and that a replacement will be purchased. Technical Violation (TV) issued. There is one (1) side gate doors with self-latching mechanisms. Passageways were observed to be clear and free of hazards. There were no bodies of water noted. LAUNDRY ROOM: The washer and dryer were observed inside a closet located between the kitchen and the office. At the time of the visit, the closet door was unlocked. LPA did not observe any cleaning supplies or detergents inside the closet at the time of the visit. Continued from LIC 9099-C Continued from LIC-9099C OFFICE: Located in the central area of the residence is an office. During today’s visit, the LPA observed that this office has doors leading to both wings of the house, and these doors were unlocked and wide open. The office is used by the administrator to store resident and employee files. Additionally, the LPA observed an unlocked chest of drawers located adjacent to the file cabinet; within two (2) of the drawers, medication such as TUMS, Pepto-Bismol, Cream USP 2.5%, Gas relief and Tylenol were noted. According to the administrator, these medications belong to the staff/caregivers. After reviewing resident’s records LPA observed that no current resident is at risk if allowed access to personal grooming and hygiene items. Technical Violation (TV) issued. Furthermore, the LPA observed a closet containing clothing items, emergency water, extra paper towels and an emergency grab-and-go bag with flashlights and resident’s spare files. DETACHED GARAGE: During today’s visit LPA inspected the detached locked garage. LPA observed wheelchairs and boxes. The garage stores items that belong to the property owner. Although the facility sketch includes the garage, the lease agreement between administrator and homeowner explicitly states that the garage space is not included in the lease and the homeowner retains access to this space at any time during the term of the lease. RECORD REVIEW: Began at 12:45 P.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, and personal rights. Two (2) resident records reviewed were missing consent form (LIC 627C). LPA emailed form to administrator and requested to include it in current and future residents. Technical Assistance was issued. Administrator will provide proof of complete form both resident. All other required forms were complete and up to date. Three (3) staff files reviewed, all containing necessary documents. Continued on LIC 9099-C Continued from LIC 9099-C MEDICATION REVIEW: Began at 2:00 P.M.; LPA reviewed medication log for all four (4) residents. Facility maintains medication in a locked kitchen cabinet. Medications are labeled and checked for expiration dates. During medication audit, LPA observed that administrator has medication for all 4 residents separated in a weekly pill organizer. LPA explained that medication shall be stored in its originally received container. LPA also reviewed the facility's Emergency Disaster Plan and Infectious Control Plan, which were observed to be complete and updated on 1/5/2025. Emergency Disaster drills are conducted quarterly, with the last drill documented on 1/5/2025. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. A $500 immediate civil penalty is assessed today. The administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Feb 25, 2025

Type of visit: Prelicensing

Licensing Program Analyst(LPA) Christine Yee conducted a pre-scheduled Prelicensing and Component III visit and met with Nelli Sadoyan, Applicant and Hrant Narinyan, Designated House Manager. The facility is a single storey family home consisting of a living room, dining room, kitchen, 3 resident bedrooms, an office, 2.5 bathrooms and a detached garage. The facility fire clearance is currently in the process of being corrected. The following were observed on today's visit: The living room is furnished with 2 sofa, an arm chair, a television and a coffee table The dining room is furnished with a table 5 chairs and the 6th chair was observed in the office. The kitchen is equipped with a dishwasher, oven, stove and microwave. Non-perishable food for a minimum of 7days were reviewed and needs to be supplemented. Perishable foods will be purchased prior to accepting the first resident. Bedroom #1 is furnished with 1 bed, 1 chair, 1 night stand, 1 lamp, a dresser and a built in closet. Curtains need to be thicker to allow for privacy Bedroom #2 is furnished with 2 beds, 2 chairs, 2 night stands, 2 dressers and only 1 portable closet. The room has a French door that opens out to a ramp. Auditory device on the door was operational. The window curtain was observed to be thin gauze and needs to be thicker to afford privacy. Located inside the bedroom is a full bathroom with a toilet, a sink, a shower, grab bars, a shower chair and a non-skid mat. Water temperature was tested and read 117.5 degrees Fahrenheit. Bedroom #2 is designated for a bedridden resident. Bedroom #3 is furnished with 2 beds, 2 chairs, 2 night stands, 2 dressers, a closet and a cupboard. Curtains need to replaced with thicker ones to afford privacy to the residents. The common bathroom located by bedroom #1 is equipped with a bath tub/shower, a sink, a toilet and non-skid mat. The shower did not have a grab bar. Water temperature was tested and read 109.5 degrees Fahrenheit. The shower room located behind the kitchen is equipped with just a shower stall. Grab bars, non-skid mat and a shower chair was observed. First aid kit was reviewed and contained just a tweezer. Scissors and thermometer was not observed. No first aid manual was observed. The only fire extinguisher purchased on 9/12/23 is located in the dining room The facility's land line number is (818)308-6030 Toxins/cleaning solutions are stored in locked cabinets in the common bathroom Dish washing solutions are stored in a locked cabinet under the kitchen sink Medications will be stored in a locked kitchen cupboard. Knives are stored in a locked kitchen drawer There were 12 each of forks, dinner knives, teaspoons, tablespoons, dinner plates, salad plates and bowls, 12 glasses and 12 cups. Pots and pans were observed. Mattress pad, fitted sheets, flat sheets, pillows and comforters were observed on the beds. Blankets were observed in bedroom #2 and 1 in bedroom #3. A blanket was missing in bedroom #1 and 1 in bedroom #3. Extra flat sheets, fitted sheets and pillow cases were in the linen closet. 6 bath towels were observed and plenty handle towels and face towels were observed. Applicant will obtain liability insurance once the facility is licensed for the required limits. Hygiene products were observed. A table and chairs for outside activities were observed in the front yard. The backyard, and the left side of the house needs cleaning and items stored in the outside areas need to be discarded or stored away and the tall grass mowed. No bodies of water was observed. The following corrections need to be made prior to licensure: A corrected fire clearance needs to be obtained from the fire department A revised LIC200 needs to be submitted to the Centralized Application Bureau to reduce the capacity from 6 to 5 residents since the room currently designated as the office does not qualify as a bedroom. A blanket need to be provided in Bedroom #1 and bedroom #3. Additional blankets and towels need to be purchased An additional portable closet needs to be purchased for Bedroom #2 A grab bar needs to be installed in the common bathroom tub/shower Non-perishable foods need to be supplemented. a pair of scissors and a thermometer needs to be purchased for the first aid kit a first aid manual that meets Title 22 needs to be purchased The window dressings in the bedrooms need to be replaced with coverings/curtain that provide privacy to the resident. The latch that is installed on the outside of left side gate needs to be removed and replaced with some other method of securing the gate to allow residents to exit freely. Applicant will notify LPA Yee once the corrections have been completed and to schedule a return visit. Anything overlooked on this visit will be addressed on the return visit. Exit interview was conducted with Nelli Sadoyanthe state’s words, verbatim · CDSS document, Dec 15, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Nelli Sadoyan Interview Method: Telephone interview On November 28, 2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 28, 2023