Safe Haven Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived unannounced at the facility to conduct the required annual inspection. The LPA was greeted by the Administrator Cristina Hernandez, 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. Smoke detector (s) and carbon monoxide detectors were tested and operational at the time of the visit. The LPA observed required postings by the front door area. KITCHEN: Kitchen knives will be stored in a locked and inaccessible kitchen drawer. A seven-day supply of non-perishable food was available, as well as water supply. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink; however. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. Two fire extinguishers were observed; one is located near the kitchen area and one in the hallway leading to the bedrooms and were last serviced on 09/10/2025.BEDROOMS: There are five (5) bedrooms for residents in care, and one(1) bedroom for staff. Rooms 1, 2, 3, and 4 are designated as single/private rooms, and bedroom five (5), is designated as a shared bedroom. All residents’ bedrooms need window screens, and window curtains/blinds. . All residents’ bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. BATHROOMS: There are four (4) bathrooms. Bathroom (#1) is in the hallway for staff and visitors. Bathroom (#2) is a shared bathroom for bedroom #5. Bathrooms (#3 and #4) are shared bathrooms between bedrooms 4, 3, 2, and 1. All bathrooms are equipped with toilet and shower grab bars. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Nonskid mats were observed. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The hot water temperature measured within the regulations. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for residents' use. There is one side gate for resident use and is single-latched. No bodies of water were noted. GARAGE/LAUNDRY ROOM: There is a laundry area equipped with washer and dryer. Detergents and cleaning supplies will be stored in a locked cabinet above the washer and dryer. The laundry area is located in the garage. The facility has an attached garage. The door will be kept locked at all times. RECORDS: 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 are centrally stored and locked in a cabinet in the kitchen area next to the refrigerator; medications are labeled and checked for expiration dates. The medications are documented properly on the centrally stored medications and destruction record. No errors were observed during the medication review. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Resident's Roster - Certificate of Liability of Insurance _ Emergency Drill Logs No citations were issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Prelicensing

On 10/04/2024, Licensing Program Analyst (LPA), Sandra Urena conducted a subsequent pre-licensing visit. The LPA arrived at the facility at 09:30 a.m. and met with Applicants Haig Boghosian and Cristina Hernandez. This is a new facility application for a Residential Care Facility for the Elderly (RCFE). On 09/06/2024, Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit at 9:53 a.m. and met with the applicants Haig Boghosian and Cristina Hernandez. This is a new facility application for a Residential Care Facility for the Elderly (RCFE). Fire Clearance was approved on 08/05/2024 for six (6) non-ambulatory residents. At 10:03 a.m., the LPA, and the applicants 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. At 09:45 a.m., the LPA and the Applicant toured the facility to ensure the corrections were completed. 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 was conducted and reviewed with the applicant. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 4, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit at 9:53 a.m. and met with the applicants Haig Boghosian and Cristina Hernandez. This is a new facility application for a Residential Care Facility for the Elderly (RCFE). Fire Clearance was approved on 08/05/2024 for six (6) non-ambulatory residents. At 10:03 a.m., the LPA, and the applicants 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. KITCHEN: Kitchen knives will be stored in a locked and inaccessible kitchen drawer; however, a lock needs to be installed. A seven-day supply of non-perishable food was available, water supply needs to be added to the seven-day supply of food. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen cleaning supplies will be stored and locked under the kitchen sink; however, a lock needs to be installed. Trash cans have a tight-fitting lid. There were no pesticides or toxins stored near food, or preparation area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. Two fire extinguishers were observed; one is located near the kitchen area and one in the hallway leading to the bedrooms. Applicant will attach a copy of the purchase receipt to each one of the fire extinguishers. BEDROOMS: There are five (5) bedrooms for residents in care, and two (2) bedrooms for staff. Rooms 1, 2, 3, and 4 are designated as single/private rooms, and bedroom five (5), is designated as a shared bedroom. All residents’ bedrooms need window screens, and window curtains/blinds. Rooms 6 and 7 are designated for staff. All residents’ bedrooms are cleared for non-ambulatory. All bedrooms were supplied with all required bedding and linens. There is sufficient lighting as well as closet and drawer space available. Bedroom #5 needs to be reconfigured so that the bathroom door does not hit side of one of the beds. Continues on LIC 809C... PG. 2 BATHROOMS: There are four (4) bathrooms. Bathroom (#1) is in the hallway for staff and visitors. Bathroom (#2) is a shared bathroom for bedroom #5. Bathroom #5 needs to have shower floor cleaned and hole on the bottom of the shower wall covered. Bathrooms (#3 and #4) are shared bathrooms between bedrooms 4, 3, 2, and 1. All bathrooms are equipped with toilet and shower grab bars. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Nonskid mats will be added to the shower area in all three bathrooms. Bathroom door in bedroom #4 needs to be level to allow for easy opening and closing. Hand washing signs as reminder of good hygiene, and paper towels to prevent cross-contamination will be added to all four bathrooms. COMMON AREAS: These include a living room space which is equipped with a television and a dining area. A fireplace is located in the dining area and has a fireplace covering. There is a dedicated area for the posting of required documents. The licensing poster will be replaced with 16” X 24” poster. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Residents’ and staff files will be stored and locked in the Staff/Office room. Linen closet is in the hallway. Night-lights will be installed in the hallways. Emergency exiting plan needs to be updated to reflect emergency meeting area. GARAGE/LAUNDRY ROOM: There is a laundry area equipped with washer and dryer. Detergents and cleaning supplies will be stored in a locked cabinet above the washer and dryer. The laundry area is located in the garage. The facility has an attached garage. The door will be kept locked at all times. OUTDOOR/SURROUNDING GROUNDS: The fire exit exterior passageway needs to be clean of debris and remove trash cans. Protruding ground pipes need to be removed/shaved to ground level. Water pipes need to be covered. The patio area has a shade; however, at the time of the visit the patio is in need of a patio table and chairs for residents’ use. An opening next to the patio wall needs to be covered. In the front of the house yard, bricks were observed be loose and need to be secured. The building has a central entrance for residents and visitors; however, no ramp was observed in the front entrance, or the kitchen entrance. All residents would need to use either one of the two ramps adjacent to the bedrooms’ hallway to get to the common areas of the facility. A ramp with handrails will need to be installed in the common area’s sliding door leading to the shaded patio area. A gate will need to be installed at the back of the house next to the garage area to prevent residents from wondering to a back passageway, which is deemed unsafe to residents in care, due to the Air Conditioning (AC) unit and other electrical cables. Cars, trucks and all construction equipment will be cleared from the outdoor patio area. Continues on LIC 809 C... page 3. Pg. 3 Pre-Licensing is incomplete with deficiencies to be resolved by Friday, September 27th, 2024.and LPA will return for a follow up visit. At 01:05 p.m., the applicant completed Component III orientation. 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 was conducted and reviewed with the applicant. A copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 6, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Haig Boghossian CEO/ Cristina Hernandez Administrator Interview Method: Telephone interview On August 7, 2024, 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 that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Aug 7, 2024