Pacific Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced required annual visit and was greeted by staff. The staff called the Administrator Viktorya Hayrapetyan on the phone and said she would arrive shortly. This is a facility for a Residential Facility for the Elderly (RCFE) for six (6) non-ambulatory residents, no bedridden residents can be admitted; all rooms were approved for non-ambulatory use. 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. COMMON AREAS: These include a living room area equipped with a television. The fireplace is non-functional and has a fireplace screen. There is a dedicated area for the posting of required documents at the entrance of the facility. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medications are stored in a locked cabinet in the kitchen area. The residents’ and staff files are stored in a closet area located in the foyer. LAUNDRY ROOM: There is a laundry area equipped with washer and dryer. The laundry room is located in the hallway between the restroom and bedroom 1. Detergents and cleaning supplies are stored in locked cabinet above the washer and dryer KITCHEN: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. 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. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 117.1 degrees Fahrenheit. 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. A fire extinguisher is located near the backdoor exit, which was purchased on 012/15/2025. Continues on LIC 809C... BEDROOMS: There are three (3) bedrooms for residents in care. Rooms 1, 2 and 3 are shared rooms; all 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 (2) full bathrooms, one with a shower and one with a shower area and a bathtub, and one (1) restroom. Bathrooms are equipped with toilets and shower grab bars, and non-skid mats. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered was 117.6 degrees Fahrenheit. SURROUNDING GROUNDS: The exterior passageways were clean. The patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. Left passageway is cleared and has a self-latching gate. The self-latching mechanism is located on the outside of the gate facing the street. The property has two ADU units. One unit is identified by the address #7731-1/2 and is located on the right-hand side of the facility(per the Administrator no one is living in the ADU). The second ADU is identified by the address #7733 and is located behind the facility and is divided by growing shrubs and a wooden gate; one person lives in this ADU. The person living in this ADU is identified as a staff member associated to the RCFE facility. RECORDS: Records review began at 11:30 a.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 12:55 p.m.; 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 observed during the medication review. The LPA reviewed the following documents: - LIC500 Personnel Report-LIC9020 Client 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, Dec 17, 2025

Allegation investigated: Staff did not ensure that resident's medical needs were met in a timely manner

Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced 10-day visit to investigate the allegation listed above. The LPA was greeted by staff. Staff contacted the Administrator Viktorya Hayrapetyan on the phone and LPA Urena explained the reason for the visit. LPA Urena, along with 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. LPA Urena interviewed the Administrator and staff at approximately 10:55 a.m. and requested and reviewed records pertinent to the investigation. Additionally, the LPA interviewed the residents at approximately 11: 25 a.m. On 12/04/2025, LPA Urena interviewed the resident’s responsible party. Continues on LIC 9099C ...page 2. Unsubstantiated Staff did not ensure that resident's medical needs were met in a timely manner. On the allegation that Staff did not ensure that resident's medical needs were met in a timely manner, it is the concern of the Reporting party (RP) that R1 did not receive timely care when staff found blood in R1’s urine (on the lining of the incontinent pad). Furthermore, the RP stated that R1 refused to go to the hospital, and it was difficult for facility staff to obtain a urine culture. To investigate the allegation, LPA Urena conducted record review, interviewed staff, administrator, R1 and R1’s responsible party. Record review indicated that R1 is alert and able to make their own decisions. The interview with the staff and the administrator revealed that they communicated immediately with R1’s responsible party about the stain on R1’s incontinent pad. The Administrator sent to R1’s responsible party a picture of the stain the staff noticed on the incontinent pad’s lining. The responsible party’s interview revealed that R1 is alert and makes their own decisions as much as possible. Furthermore, R1’s responsible party stated that when they received the picture of the lining of the incontinent pad, it appeared to be a brownish stain. The party responsible stated that it could have been due to slight dehydration and asked facility staff to provide and ask R1 to drink more water and see if it would resolve the occurrence of the brownish discharge. The party responsible asked the Home Health nurse to get a urine sample to be evaluated for blood, however, R1 refused; and when R1 was told that it would be best to get them to the hospital for the benefit of their health, R1 adamantly refused to go to the hospital. The party responsible added that the brownish discharge cleared the same day. The staff's interview revealed that R1's incontinent pad only had one occurrence when the brownish stain was visible. They checked R's incontinent pad 30 minuets after for at least a period of three hours and the incontinent pad was clear. LPA Urena attempted to interview R1, however the LPA was able to obtain only yes, and no answers due to R1’s speech; nevertheless, R1 was able to answer yes to questions related to the care R1 receives at the facility, as being good and denying having any physical concerns, and not wanting to go to the hospital. Based on the information gathered through interviews, and record review, the facility staff followed regulations and protocol by informing R1’s responsible party about the concern and possible medical needs for R1 in a timely manner. The facility staff attempted to send R1 to the hospital to be assessed and R1 refused. Therefore, the allegation is deemed Unsubstantiated at this time. Interview exit was conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Dec 5, 2025 · control 29-AS-20251126100943

Allegation investigated: Staff neglect resulted in resident sustaining multiple pressure injuries. Staff did not ensure resident's toileting needs were met. Staff are unable to communicate with resident due to a language barrier.

Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint visit to deliver final findings for the allegations cited above. During today’s visit, LPA Urena was greeted by staff, staff contacted the Administrator VIKTORYA HAYRAPETYAN on the phone and the LPA explained the reason for the visit. Administrator was unable to come to the facility and agreed to have the report read over the phone, and asked staff Emilia Hovsepyan to sign the report on their behalf. On 04/22/2025, the Woodland Hills North Adult & Senior Care Regional Office (WHNASC) Regional Office (RO) received a complaint alleging that the Pacific Senior Care facility staff neglected the care of Resident #1 (R1), resulting in several pressure injuries while in care. On 04/22/2025, the RO referred this case to the Investigations Branch, and Investigator John Canto, was assigned to complete this investigation. Continues on LIC 9099C 2... Substantiated pg. 2 On 04/24/2025, Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations listed above. The LPA was greeted by staff and contacted the Administrator. The Administrator Viktorya Hayrapetyan arrived at 11:59 a.m., and the LPA informed them of the reason for the visit. LPA Urena interviewed the Administrator and residents and requested documents pertinent to the investigation from approximately 10:30 a.m. to 01:15 p.m. The Administrator was advised that the complaint was referred to the Investigations Branch (IB). The LPA determined further investigation was needed prior to issuing findings. Staff neglect resulted in resident sustaining multiple pressure injuries. On 05/06/2025, from approximately 10:00 a.m. to 11:45 a.m., Investigator Canto and Investigator Rojas conducted interviews with R1, Administrator, residents and Staff #1 (S1) and Staff #2 (S2); on 06/27/2025 from approximately 11:00 a.m. to 11:30 a.m. with residents; on 07/02/2025 at approximately 10:45 a.m. with RP; and on 07/02/2025 from approximately 11:15 a.m. to 11:20 a.m. Investigator Canto attempted to interview Staff #3 (S3) and Staff #4 (S4) via telephone. Investigator Canto left voicemails for S3 and S4, and messages were not returned. In addition, Investigator Canto reviewed Kaiser Permanent Medical Records, Doctor’s Choice Home Health Records, Infinite Home Health Records, and facility’s file documents related to the investigation. According to R1’s Physician Report, dated 02/19/2025, the primary diagnosis was noted as an unspecified dislocated left shoulder secondary to a fall. R1 was noted to require assistance when transferring to and from bed. R1 was admitted to the facility on 02/19/2025. Continues on LIC 9099C pg. 3... pg.3 The record review revealed that R1 had been at the facility for several months after sustaining a fall at their home. R1 required rehabilitation and was transferred to a rehabilitation center, then subsequently admitted on 02/19/2025 to the Pacific Senior Care facility. R1 said they lived alone and could no longer care for themselves. The facility’s Pre-Placement Appraisal revealed that R1 requires assistance in toileting, including assistance with equipment or assistance from another person when translocating. R1 requires assistance in changing their adult briefs and the assistance of another person in providing peri-care, hygiene, continence, bowel, or bladder control. In February 2025, Choice Home Health Services noted that several Stage I pressure injuries developed on R1’s heels and buttocks. In April 2025, a review of Infinite Home Health records noted that the pressure injuries were at Stage II, pressure injury present on the interior portion of R1’s left elbow due to the positioning of R1’s body. R1 is also acquiring a Stage II pressure injury on the right buttock and sacral area. Review of the Kaiser medical records noted, “attributed to prolonged bed rest and the use of diapers. R1’s inability to get out of bed has likely contributed to the development of the rash. Severe decubitus ulcer on the buttocks, likely infected, exacerbated by prolonged immobility and diaper use.” Interviews with staff revealed, the NOC and PM staff did not change female resident’s undergarments such as adult briefs or soiled clothing to avoid residents feeling embarrassed or disrespected and would refer to a female staff. Staff stated during the NOC shift residents are usually asleep. An interview with Resident #2 (2) revealed they sometimes need assistance with repositioning but are rarely repositioned. Although the facility’s records note the dates and times R1 was bathed and/or repositioned; the information gathered noted that the staff did not provide adequate care for R1, resulting in a severe decubitus rash. Furthermore, the RP witnessed the staff perform improper care for toileting, including decreased unwillingness to change, wet and soiled undergarments, as well as to clean the patient and assist in applying medicated ointment to the pressure injury to prevent further issues; and residents’ interviews revealed that facility staff rarely assist with repositioning residents in care. Continues on LIC 9099C pg. 4 pg.4 The information gathered, noted the pressure injuries were documented under the allowed stage; however, the injuries appeared to be exacerbated to a Stage II because of the lack of repositioning, and lack of adequately changing the adult's briefs as needed. Therefore, the allegation of Staff neglect resulted in resident sustaining multiple pressure injuries is deemed Substantiated at this time. Staff did not ensure resident's toileting needs were met On the allegation that Staff did not ensure resident's toileting needs were met. The RP’s concern is that R1 had a soiled undergarment at the time of the visit, and that staff did not change the undergarment until the RP requested the staff to change R1’s soiled undergarment. The interviews conducted by Investigator Canto and Investigator Rojas revealed that the NOC and PM staff did not change female resident’s undergarments such as adult briefs or soiled clothing to avoid residents feeling embarrassed or disrespected and would refer to a female staff. NOC staff stated that they are usually by themselves, and no female staff is present during the night shift. Staff stated during the NOC shift residents are usually asleep. Based on the information obtained through interviews, the allegation that staff did not ensure resident's toileting needs were met, is deemed Substantiated at this time. Staff are unable to communicate with resident due to a language barrier; On the allegation that Staff are unable to communicate with resident due to a language barrier; It is the RP’s concern that staff is unable to communicate with residents due to staff not speaking or understating English. LPA Urena interviewed R1, and the interview revealed that it is difficult to communicate with the staff because they don’t understand or speak English. LPA Urena attempted to interview the staff, and the staff could not readily respond to the questions asked by the LPA. The staff attempted to use a translation application; however, the Administrator attempted to step in and respond for the staff. The LPA concluded the staff’s interview. The residents’ interviews conducted by Investigator Canto and Investigator Rojas revealed that they feel uncomfortable because they feel that staff do not understand English, and there is a communication barrier. Based on information obtained through interviews, there is sufficient evidence to support the allegation of staff not being able to communicate with residents due to staff’s language barrier. Therefore, the allegation is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations (CCR) and Health and Safety Code, the following deficiency was cited (refer to LIC 9099-D).The Administrator was informed that a civil penalty might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f).” Citations were issued. Exit interview conducted. A copy of the report and Appeal Rights were issued. Staff left resident in soiled clothing. On the allegation that Staff left resident in soiled clothing; it is the RP’s concern that they observed that R1 was wearing a soiled shirt that was not changed by the staff at the time of their visit. On 09/11/2025, LPA Urena interviewed residents about staff assisting with changing their soiled clothing, and the residents stated that staff change their clothing every day. Furthermore, the LPA interviewed staff, and staff stated that they change the resident’s clothing every day, and as necessary. Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation that Staff left resident in soiled clothing is deemed Unsubstantiated at this time. Staff do not provide residents with a sufficient amount of food. On the allegation that staff do not provide residents with sufficient food, it is the RP’s concern that they witness very small portions of food served to residents. The food portions appeared to the RP to be more suited for a small child than to an adult. To investigate the allegation, LPA Urena interviewed residents. Residents stated that they get three meals a day and snacks are offered, and residents can request as well. The residents stated that the portions of food are adequate and if they request more food, the staff will give them more food. Staff’s interviews revealed that they provide three meals a day and offer snacks, fruit, cookies etc. to residents during the day and in between meals. A physical plant observation of the kitchen revealed that there was sufficient food and at least a two-day perishable supply of food. Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation that Staff do not provide residents with a sufficient amount of food. is deemed Unsubstantiated at this time. Exit interview was conducted, and a copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 30, 2025 · control 29-AS-20250422092330

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Nov 7, 2025

87464(f)(1) Basic Services.(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). (c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living …Assistance includes assistance with taking medications, money management, or personal care.This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above, as R1 was not repositioned and staff performed improper care for toileting, including decreased unwillingness to change, wet and soiled undergarments which resulted in R1 sustaining a stage II wound on the interior portion of R1’s left elbow due to the positioning of R1’s body. R1 also acquiring a Stage II pressure injury on the right buttock and sacral area which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Licensee will …submit a plan to ensure proper incontinent care and repositioning is being provided to the residents. Submit to CCL by …

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2 · Plan of correction due date: Nov 7, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4)To care…and services that meet their individual needs and are delivered by staff that are sufficient in … qualifications, and competency to meet their needs.This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as residents cannot readlily communicate with staff due to language barrier.the state’s words, verbatim · CDSS document, Oct 30, 2025

Plan of correction: Licensee will submit a plan to ensure residents can readily and promptly communicate their needs to staff Submit to CCL by …

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena conducted a Pre-licensing visit and met with the applicant Viktorya Hayrapetyan. This is a new facility application for a Residential Facility for the Elderly (RCFE ) for six (6) non-ambulatory residents, no bedridden residents can be admitted. Fire Clearance was approved on 05/13/2024 for all rooms for non-ambulatory use. At 11:15 a.m., the LPA, and the applicant 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: Kitchen knives are stored locked and inaccessible in a locked kitchen drawer. 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. Kitchen cleaning supplies will be stored and locked under the kitchen sink. Hot water temperature was recorded at 118.1 degrees Fahrenheit. 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. A fire extinguisher is located near the backdoor exit, which was purchased on 04/19/2024. BEDROOMS: There are three (3) bedrooms for residents in care. Rooms 1, 2 and 3 will be a shared rooms; all 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. Bedrooms (1 and 2) closets will have a divider installed to separate residents clothing. Bedroom 3 closet will be cleared of items (wheelchairs, walkers, storage items, etc.) BATHROOMS: There are (2) full bathrooms, with shower and bathtubs, and one (1) restroom. Bathrooms are equipped with toilets and shower grab bars, and non-skid mats. There are sufficient supplies of towels, paper goods and personal hygiene supplies. Hot water delivered was between 117.6 to 119.1 degrees Fahrenheit. Continues on LIC 809C... COMMON AREAS: These include a living room area equipped with a television. The fireplace is non-functional and has a fireplace screen. There is a dedicated area for the posting of required documents at the entrance of the facility. Smoke and carbon monoxide alarms were tested and functional at the time of the visit. Medications will be stored in a locked cabinet in the kitchen area. The residents’ and staff files will be stored and locked in a closet area located in the foyer. LAUNDRY ROOM: There is a laundry area equipped with washer and dryer. The laundry room is located in the hallway between the restroom and bedroom 1. Detergents and cleaning supplies will be stored in locked cabinet above the washer and dryer. SURROUNDING GROUNDS: The exterior passageways were clean. Some items such as buckets and other outdoor items will be removed. The patio is furnished with outdoor furniture for residents’ use, and shade is available. The building has a central entrance for residents and visitors. Left passageway is cleared and has a self-latching gate. The self-latching mechanism is located on the outside of the gate facing the street. At the time of the visit the LPA observed two ADU units. One unit is identified by the address #7731-1/2 and is located on the right-hand side of the facility; one person lives in this ADU. The second ADU is identified by the address #7733 and is located behind the facility and is divided by growing shrubs and a wooden gate; two people live in this ADU. Applicant stated that all persons living in the two ADU units have been background cleared and associated to the facility. LPA Urena will verify the clearances and association to the facility upon returning to the Regional Office. Continues on LIC 809C... Pre-Licensing is incomplete with deficiencies to be resolved by Friday, 12/20/2024. Follow up Pre-licensure LIC809 will be generated upon resolution. · The Licensing Complaint poster will be moved to a more prominent area. · Linen closet will be installed to keep all linens and towels stored. · Bedrooms (1 and 2) closets will have a divider installed to separate residents clothing. · Bedroom 3 closet will be cleared of items (wheelchairs, walkers, storage items, etc.) · Applicant will inform CAB of the new facility telephone number. · Applicant will obtain Emergency lighting supplies (flashlights, batteries) and keep at facility. At 01:32 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, Dec 17, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Viktorya Hayrapetyan, CEO/Administrator Interview Method: Telephone interview On 11/12/24, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/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 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, Nov 12, 2024