Dream Haven Care

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Angela Barutyan and Quoc Huynh arrived at the facility unannounced to conduct a required annual visit at 9:32AM. The LPAs met with Staff who contacted the Administrator. The Administrator Maya Moskovyan arrived shortly thereafter. Entrance interview conducted. Beginning at 9:40AM, the LPAs, Staff, and 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: KITCHEN: The LPAs observed knives and cleaning supplies stored inaccessible in the kitchen. Kitchen appliances were clean and in operable condition. The facility had a supply of perishable and non-perishable food, as well as emergency food and water. The LPAs advised the Administrator to obtain additional emergency water, which was obtained during the visit. Food in the refrigerator and freezer were observed to be properly stored with labels and dates. The LPAs observed a resident’s refrigerated medication that was not secured. The Staff explained the medication bottle itself was secured and that it did not pose a risk to the residents if accessed. The LPAs informed them that all centrally stored medications are required to be secured and inaccessible. The Administrator stated the facility has a lock box for refrigerated medications and LPAs observed the Administrator to secure the refrigerated medication. The remainder of centrally stored medications were secured in a cabinet. Report Continued on LIC 809-C COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. A fireplace was observed to be properly screened in the dining area. There was an office located near the kitchen with a laundry closet that was not secured during the visit. Machines were observed to be in good condition, and laundry detergent was observed. The facility maintained a comfortable temperature throughout the visit. Required postings were observed in the entryway along with a closet containing general supplies. Smoke and carbon monoxide detectors were tested at 10:21AM and were operational. LPAs observed the fire door to the hallway that was kept open with a tie on the handle, preventing it from shutting during LPAs’ smoke detector testing. LPAs explained that fire doors shall not be restricted. Administrator stated she will obtain a magnetic door stopper that is in compliance with fire code. BEDROOMS/RESTROOMS: There were four (4) bedrooms total. Bedroom #4 is cleared for one (1) bedridden resident and had a direct exit to the outside. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Bedroom #4’s mattress did not have a fitted sheet. The Staff and Administrator stated that they were laundering the linens; however, the LPAs did not observe the laundry machines to be in use during the visit. They then explained that the resident often soils their bed and requires a waterproof mattress pad, which was observed in lieu of the fitted sheet. The LPAs explained that regardless of the reason, the facility is required to ensure linens are provided at all times. LPAs observed staff put the fitted sheet on the mattress. Extra linens and supplies were stored in hallway cabinets. There were two (2) total restrooms in the facility: one (1) private resident restroom and one (1) shared resident restroom. Restrooms were clean and sanitary and in operating condition with grab bars and non-slip surfaces. All restrooms were sufficiently stocked with soap and paper products. Hot water was tested and measured between 107.6 degrees F and 125.8 degrees F, which is not within the required range. Administrator lowered the water heater during the visit. OUTDOOR AREA: The surrounding grounds had a shaded patio area equipped with furniture in good condition for resident and visitor use. The rear property had two (2) additional dwelling units (ADUs) that were unrelated to the facility’s operations. Three (3) emergency side exits were observed and all were locked with padlocks. The Administrator stated that Staff have the key and the LPAs explained that emergency exits should be unlocked in the event of emergencies. LPAs observed the facility’s fire clearance, which does not approve the use of a locked or secured perimeter. LPAs explained that the locked exits are a violation of the facility’s fire clearance. Staff removed the locks during the visit. Report Continued on LIC 809-C MEDICATIONS: Medication review began at 10:29AM. Medications were centrally stored and kept inaccessible in the kitchen. Medications were observed for two (2) residents. Medications were labeled and checked for expiration dates and were properly documented on the centrally stored medications and destruction record. Resident #1 (R1) did not have a centrally stored medication and destruction record. The Administrator stated that the resident was admitted on 09/18/2026, and they have not completed a medication record as the resident will be moving to another facility tomorrow, 09/23/2026. LPAs explained that R1 should still have a record as they are a resident at this facility. RECORDS: Record review began at 01:14PM. Five (5) out of five (5) resident records were reviewed for, but not limited to care plans, physician's report, admissions agreement, and consent forms. The Administrator stated that R1 did not have a complete record as they had seven (7) days to complete and noted that an admission agreement was not signed upon admission. The LPAs explained that all residents should have a signed admission agreement and assessment prior to admission. Three (3) personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Two (2) personnel files were missing valid health screenings and TB tests, and one (1) staff file was missing First Aid/CPR training. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, LPA reviewed the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and reviewed annually as required. Emergency disaster drills are conducted quarterly, with the last documented drill on 09/01/2026. A fire extinguisher was observed and was last purchased on 09/17/2026. An immediate civil penalty in the amount of $500 was assessed for a violation of the facility’s fire clearance. The Administrator was advised that failure to correct or continued violation may result in additional civil penalties. Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code the following deficiencies were cited (Refer to LIC 809-D). Administrator was unable to stay for the remainder of the visit and designated staff member, Naira Gevorgyan, to sign the report. Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 23, 2026

The state marks this report as 12 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Valeria Conway conducted a Case Management - Deficiencies visit in conjunction with a complaint visit. The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation. During today's visit, LPA observed two (2) staff members, Staff #1 (S1) and Staff #2 (S2), in the kitchen preparing and serving lunch for residents in care. A review of the Personnel Report (LIC 500) and the Guardian system revealed that S2 was not on the facility's roster,fingerprinted, nor associated to the facility. The Licensee stated that S2 was shadowing S1 and receiving training. The Licensee further stated that S2 had their fingerprints taken on 08/09/2026 and was awaiting completion of the precess before being hired. Furthermore, the Licensee acknowledged that S2 had been provided care and services to residents as S2 was present during an incident that occurred on 08/07/2026. Additionally, LPA reviewed R1's records, who was admitted on 10/17/2025, and observed that the admission documentation, including but not limited to the Admission Agreement, Need and Service Plan, Physician Report and consent forms had not been signed by R1 or their responsible person. The Licensee stated that R1's responsible person visits often. However, the licensee acknowledge that they were not aware the required documentation had not been signed and update. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. Civil penalties were issued in the amount of $500. Failure to correct the deficiencies may result in additional civil penalties. Exit interview was conducted. A copy of the report and appeal rights and civil penalties were provided.the state’s words, verbatim · CDSS document, Aug 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87506 · Plan of correction due date: Aug 18, 2026

87506(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 is not met as evidenced by… Licensee did not comply with the regulation cited above as Admission Agreement, Need and Service Plan, Physician Report and consent forms had not been signed by R1 or their responsible person which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Licensee agrees to write a statement of understanding regarding this regulation and if R1 comes back to the facility, all onbording documents will be updated and signed by R1's responsible party.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e) · Plan of correction due date: Aug 17, 2026

87355 (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by… Licensee did not comply with the regulation cited above as there was an individual (S2) providing care and services to residents in care. which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2026

Plan of correction: Licensee removed S2 immediately from the promises and acknowledge that ALL individual providing care and supervision SHALL have a clearance prior to provide assistance. LPA requested to have this information in writing due to prior similar citations.

Allegation investigated: Staff physically abused a resident

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct an initial complaint investigation for the allegation listed above at 11:02AM. LPA was greeted by staff and Licensee Maya Moskovyan who arrived during the visit. Entrance interview conducted. During today's visit, LPA conducted a physical plant tour between 11:04AM-12:10PM, interviewed five (5) residents and two (2) staff between 11:19AM-01:30PM, and discussed allegation with Licensee at 02:20PM. It was alleged that on 02/12/2026 around 5PM, Staff #1 (S1) got into an argument with Resident #1 (R1) leading to an injury. S1 brought R1 soup in a bowl, R1 requested the soup to be brought in a cup with a straw. After S1 brought the soup as requested, S1 and R1 got into an argument and scuffle over the soup. REPORT CONTINUED ON LIC9099-C. Unsubstantiated During the scuffle, soup spilled onto R1’s sheets and S1 shut R1’s open laptop that was on their lap. It was alleged that the laptop shutting caused pain to R1’s shin. LPA interviewed five (5) residents, including R1. All residents had no complaints of staff or S1. Residents stated they are happy with their care and had no concerns about S1. Residents stated they have not witnessed or heard of any mistreatment from S1. R1 denied any incidents and had no concerns. R1 stated they are very comfortable and that R1 treats them with great care. R1 denied any pain in their shins. LPA interviewed one (1) staff and the Licensee who stated that S1 held the mug in R1’s hand in self-defense as R1 was attempting to throw the cup at S1. Staff stated that S1 shut R1’s laptop because soup spilled on the sheets and S1 was preventing the soup from getting on the laptop. Staff stated that during this incident, R1 slapped S1 across the face with their other hand that was not gripping the mug. During today’s visit, LPA was unable to review or obtain copies of records such as staff training and resident files as Licensee did not have the key to the locked file cabinet. Citation cited on a separate case management report. Based on interviews, the information obtained during the investigation does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the above allegation “Staff physically abused a resident” is deemed UNSUBSTANTIATED at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 23, 2026 · control 29-AS-20260217162548

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Barutyan conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20260217162548). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation. During the visit on 02/23/2026, LPA requested resident, staff, and facility records. Licensee Maya Moskovyan was unable to provide LPA with records for review as the records were stored in a locked file cabinet and Licensee stated she did not have the key. Administrator Elena Kordonskiy was unable to arrive for the visit and unlock the file cabinet. LPA was unable to review or obtain copies of records during the visit. Licensee stated they will provide copies of requested records to LPA via email by tomorrow 02/24/2026. LPA also observed Staff #1 (S1) during the visit. LPA interviewed other staff present who stated that S1 is not an employee. LPA interviewed residents who stated that S1 and their spouse, Staff #2 (S2), provide care to them. LPA interviewed the Licensee who confirmed that S1 and S2 are employees at the facility and provide care. S1 and S2 did not have a transfer of criminal record clearance. Licensee attempted to associate S1 and S2 to the facility during the visit but was unable to. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. Civil penalties were issued in the amount of $1000. Failure to correct the deficiencies may result in additional civil penalties. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 23, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Feb 24, 2026

Criminal Record Clearance (e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (3)Request a transfer of a criminal record clearance... This requirement is not met as evidenced by: Based on observation and interview, the Licensee did not comply with the section cited above as two (2) employees did not have a transfer of criminal record clearance. This poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 23, 2026

Plan of correction: Licensee attempted to associate both staff members during the visit but was unable to. Licensee will provide proof of association to LPA by the due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87755(c) · Plan of correction due date: Mar 2, 2026

Inspection Authority of the Licensing Agency (c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above as resident, personnel, and staff records were not available for review or copies during LPA's visit. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 23, 2026

Plan of correction: Licensee stated they will email all requested records to LPA by tomorrow 02/24/2026. Licensee stated they will keep a copy of the file cabinet keys at the facility to ensure records are available for review during licensing inspections. Licensee will submit a signed statement of understanding of the section cited to LPA by the due date.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Angela Barutyan conducted an announced pre-licensing visit to the facility noted above at 10:00AM. LPA met with Administrator Sevak Tsaturyan, Applicant Maya Moskovyan, and Applicant Representatives Lusine Tadevosyan and Vahan Aghabekyan. The applicant has obtained fire clearance for a total capacity of six (6) residents. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The facility is one story. The facility has four (4) bedrooms total; two (2) are shared resident bedrooms and two (2) are private resident bedrooms. Three (3) resident bedrooms are cleared for nonambulatory and one (1) bedroom, Bedroom #4, is cleared for bedridden. The combination smoke alarm/carbon monoxide detectors and fire door were tested and functioned properly. LPA observed one (1) fire extinguisher to be fully charged and purchased on 07/02/2025. LPA toured the kitchen area at approximately 10:05AM. The hot water temperature was measured in the kitchen sink, and it measured at 105.1 degrees Fahrenheit. Appliances and all equipment appear to be clean and in good repair. The kitchen has a sufficient supply of plates, cups, cookware, utensils, and non-perishable foods. Kitchen knives and sharps are locked in a cabinet drawer. LPA observed emergency food and water supplies. There is a laundry unit by the kitchen and office area. Additional cleaning supplies, toxins, detergents, disinfectants, and cleaning supplies were stored locked in a hallway closet. Report Continued on LIC 809C. Report Continued from LIC 809C. Resident bedrooms are equipped with clean mattresses, pillows, and bedding. Bedrooms have sufficient lighting. There is a sufficient supply of linens, including blankets, bath towels, and wash cloths. The facility has two (2) bathrooms for resident use; one (1) is in the hallway and one (1) is attached to Bedroom #1. Bathrooms contained appropriate slip-resistant surfaces and grab bars. Hot water temperature was measured in all bathrooms, and they measured between 105.6-105.8 degrees F which is within the required range. The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. LPA observed enough seating for six (6) residents at the same time in the dining room table. A working telephone is present. There are activity supplies in the living room. Night-light was present in the hallway. Medications will be stored and locked in a cabinet by the kitchen as well as facility records and First aid kit. First aid kit was observed to have bandages, thermometer, scissors, tweezers, and a current first aid manual. Cameras were observed outside and in common areas and do not record audio. There will be no firearms/ammunition stored on the property. The facility has required postings, including Emergency Exit Plan, Licensing Complaint Poster, Resident Personal Rights, and Theft and Loss Policy. The exterior passageways were free of obstructions. Emergency side gate was self-latching. There were no bodies of water on the premises. LPA observed the backyard, which has a covered outdoor area with a table and chairs for resident use. There is an accessory dwelling unit (ADU) where staff will sleep. Auditory exit alarms were functioning properly. Physical plant is consistent with the submitted facility sketch/floor plan. Comp III conducted with Applicant and Administrator. Pre-Licensing is complete and this facility has no deficiencies. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. The report was reviewed, and a copy was provided.the state’s words, verbatim · CDSS document, Sep 10, 2025