Vikmed

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit due to deficiencies observed during a complaint visit to the facility today. LPA Yee was let into the home by Meruyert Kabulova, the only staff present at the facility. Lilit Mkhitaryan, Administrator was contacted by staff and she arrived at the facility at 10:42am to conduct today's visits. During the visit today, LPA Yee reviewed the Personnel Report for the facility and observed that Meruyert Kabulova, Staff was not listed on the Personnel Report printed on 8/5/26. A call was made to the Woodland Hills Regional Office to confirm the criminal background clearance status of Ms. Kabulova with Department staff. Per information provided on the call, Ms. Kabulova was cleared on 6/9/25 and worked at another facility. Per review of the activity online, the facility had initiated something on 8/6/26 and the status indicated "not yet submitted" as of the time of the call. Department information also confirmed that the criminal record clearance for Ms. Kabulova's was not transferred to this facility Per interview conducted with the Administrator, Ms. Kabulova is not staff. She was covering for her while she stepped out for 10 minutes. LPA Yee arrived at the home at 10:13am and Administrator returned at 10:42am. Per the Administrator, Ms. Kabulova started her training 2 day's ago - 8/4/26 because another staff had a medical emergency. Per the Administrator, Ms. Kabulova has also completed training. There were no staff file or evidence of criminal record clearance provided except a live scan request form. Also prior to the Administrator's return, Resident #1 requested assistance and they and LPA Yee were informed by the only continued on LIC809-C Page 2. staff that they were in the process of changing a resident. Resident had to wait for assistance. Per review of Department records, the facility was also previously cited under the same Title 22 Section 87355(e)(3) on 5/28/26. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Civil Penalties of $300 were assessed for failure to request a criminal background transfer for Ms. Kabulova and $250 was assessed for a repeat citation within 12 months on today's visit. Exit interview was conducted, APPEALS RIGHTS were discussed and a copy was provided.the state’s words, verbatim · CDSS document, Aug 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Aug 7, 2026

Criminal Record Clearance: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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or..this requirement was not met as evidenced by: Meruyert Kabulow, Staff was observed providing care to the residents today and since 8/4/26 without having requested a criminal record transfer.Civil penalties of $300 was assessedthe state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: Licensee will ensure that all staff, volunteers and anyone who requires a criminal record clearance is cleared and associated PRIOR to being present at the facility. Licensee will either associate the staff via Guardian or submit an LIC9182 with a legible copy of a government identification to request the criminal background clearance to have MeruyertKabulova associated to the facility by 8/7/26.

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 staff and informed them of the reason for the visit. Administrator Lilit Mkhitaryan arrived shortly thereafter. 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. The fire extinguisher was fully charged and was last purchased on 05/28/2026. The LPA observed required postings throughout the common space. The hallway between bedrooms # 1 and #3 and the hallway bathroom is missing a sensor night light. KITCHEN: Knives and cleaning supplies are stored in drawer with a broken lock, and potentially accessible to residents in care. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food, however there was not sufficient water for seven (7) days. The LPA observed residents’ medications accessible in the refrigerator’s door, and on the last bottom shelf of the refrigerator. BEDROOMS: There are three residents’ bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are two bathrooms, one in the hallway, and one in a bedroom #2. The LPA observed the three bedrooms’ closets as being used for storage (Bed liners, disposable incontinent supplies, bed foams, etc.) LPA observed Bedroom #3 being used as passage way to the back yard area. The home is fire cleared for five (5) NON-AMBULATORY and one (1) BEDRIDDEN residents. Bedroom #1 and Bedroom #2 are approved for bedridden use. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is one fire cleared side gate for client use, which has single-latch on the inside of the property. At the time of the visit the LPA observed the gate to be secured with a metal string and unable to open the gate from the outside. No bodies of water noted. A second metal gate outside bedroom #1 was observed to be open and unlocked. The gate leads to a concrete steps and side of the facility which is not cleared by LAFD. The washer and dryer are inaccessible in the washer and dryer closet located in the hallway. No cleaning supplies and/or disinfectants were observed in this closet. Due to time constraints, LPA Urena will return on another date to complete the Annual inspection.the state’s words, verbatim · CDSS document, Jun 10, 2026

Allegation investigated: . Staff do not treat residents with dignity and respect 2. Staff throw food at residents 3. Staff push residents

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and was let into the home by Alisa Arshakyan, Staff. Staff contacted Mane Gevorgyan, Licensee and Lilit Mkhitaryan, Staff and only Lilit Mkhitaryan arrived at 11:08am to conduct the visit. Per information provided Mane Gevorgyan is only present at the facility on Tuesdays. The reason for today's visit was explained. On today's visit, LPA Yee conducted interviews with Lilit Mkhitaryan, Staff #1, at 2;28PM, Staff #1 at 2:37pm, Resident #1 at 2pm, Resident #2 at 2:06pm, Resident #3 at 2:10pm, Resident #4 at 2:16pm and was unable to interview Resident #5 at 2:22pm as they were asleep during the visit. Copies of documents were collected for 3 Residents. continued on LIC9099-C Unsubstantiated Page 2. The investigation into Allegation #1 Staff do not treat residents with dignity and respect, per interviews conducted with Resident #1 through Resident #4, revealed that the staff do not mistreat them, are not rude or mean to them. The staff are nice and treat them with dignity and are respectfully. They do not have any complaints about the staff. Staff interviewed also deny that they mistreat the residents and are not rude or disrespectful to the residents. Per Staff #1, the residents like her.. The investigation into Allegation #2 Staff throw food at residents, per interviews conducted with residents, it revealed that staff do not throw food at them. Staff put their food in front of them and will assist them if they need help. Per Resident #1, they have lived here a short time and have not seen staff throw food at anyone. Per Resident #1, there was a friend who was visiting and saw a staff who was working here only one time, forcefully put a plate of food down in front of them and thought it was rude. Per Resident #1, it may be a cultural thing but it did not bother them. It bothered the friend. Per Resident #1, the regular staff have not thrown food at them and that staff has not returned to the facility. Resident #1 was not able to provide a name for that staff. Per interviews conducted with staff, they only have 4 regular staff working at the facility. There has been no other staff working here. Per interviews conducted regarding Allegation #3 Staff push residents, all residents interviewed state that the staff do not push them and they have not observed any staff pushing any other residents. Based on the information received on today's visit, there was insufficient evidence to support the allegations that Staff do not treat residents with dignity and respect, Staff throw food at residents and Staff push residents, therefore all three (3) allegations are unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 28, 2026 · control 29-AS-20260521135928

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit due to deficiencies observed on today's visit. LPA Yee was let into the home by Alisa Arshakyan, Staff contacted Mane Gevorgyan, Licensee and Lilit Mkhitaryan, Staff. Lilit Mthitaryan arrived at 11:08am to conduct the visit. Per information provided, Mane Gevorgyan, Licensee is present at the facility on Tuesdays. The reason for today's visit was provided. On today's visit, LPA Yee observed the following deficiencies: Liana Martirosyan, new Applicant, does not have evidence that a request for a criminal record transfer was submitted and works at the facility on Sunday, Thursday on Friday. Lilit Mkhitaryan, is currently not associated to the facility and was not cited on today's visit pending verification of receipt of a Criminal Record Clearance Transfer submitted in February 2026. A return visit will be conducted if needed. Liana Martirosyan and Mane Gevorgyan do not have files available at the facility for Department review. Resident #5 was placed on hospice palliative care 20 days ago and has a wound on the right calf and on the lower back and there is no hospice care plan in place, no evidence of training by the nurse, no agreement with the hospice agency and the Department was not notified of the initiation within 5 day of initiation. . Licensee will provide a copy of the LIC500 with names of staff and staff schedule by 6/4/26. Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Immediate civil penalties were assessed. Exit interview was conducted, Appeals Rights were discussed and a copy was provided.the state’s words, verbatim · CDSS document, May 28, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: May 29, 2026

Criminal Record Clearance: 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: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement was not met as evidenced by: Per file review, Liana Mirtarosyan, Applicant is not associated to the facility and works on Sunday, Thursday and Friday at the facilitythe state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: Licensee will ensure that all staff have received a criminal record clearance and have requested a criminal record transfer prior to being present at the facility. Facility will submit a written statement as to how they will come into compliance or associate Liana Martirosyan on Guardian by 5/29/26 or complete an LIC9182 with a legible copy of a government document, such as a driver license to have Liana Martirosyan associated by 5/29/26

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(f) · Plan of correction due date: Jun 4, 2026

Personnel Records:All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement was not met as evidenced by: Mane Gevorgyan and Liana Martirosyan's files were not available for reivew when requested. Mane Gervorgyan's file was at her residence and Liana's file was at Lilit's residence.the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: The Licensee will ensure that all staff and residents' files are maintained at the facility and made available within a reasonable time for Department review. Licensee will ensure that a copy of Mane Gevorgyan and Liana Martirosyan files are maintained on the premises by 6/4/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(a)(4) · Plan of correction due date: Jun 4, 2026

Hospice Care of Terminally Ill Residents: The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services..when all the conditions are met. A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or ....the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: Licensee will review Title 22 Section 87633 Hospice Care of Terminally III Residents and submit a written statement that the section was read and the facility will adhere to the condition required to retain a terminally ill resident. Also provide evidence that all the required documents, training,care plan and agreements have been obtain for Resident #5 and maintained on site for review by 6/4/26

From the deficiency page — Deficiency type: Type B · Section cited: CCR87632(d)(2) · Plan of correction due date: Jun 4, 2026

Hospice Care Waiver: If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents ...The licensee shall notify the Department in writing within five working days of the initiation of hospice care for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. Facility did not report hospice initiation for Resident #5the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: Licensee will ensure that the conditions noted in the approved Hospice Waiver granted is adhered to. The licensee will submit a written notifiication of hospice initiation to the Department for Resident #5 by 6/4/26.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the home met Title 22 requirements. The CARE Inspection Tool was used on today's visit. LPA Yee met with Mane Gevorgyan, Applicant. The home is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms and 2 full bathrooms. Located in the back of the home is a detached garage. The home is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #1 and Bedroom #2 are approved for bedridden use. The following was observed on today's visit: The living room is furnished with a sofa for 4 residents and a chair, coffee table, a side table, 2 end tables and a television. An additional chair will be added by the applicant. The fireplace was observed with a fire screen. The dining room is furnished with a table, 6 chairs, a desk and a locked filing cabinet. The kitchen is equipped with a stove, refrigerator, dishwasher and a microwave Sufficient dinner plates, salad plates, soup bowl, cups, glasses and utensils for 6 residents were observed. Pots and pans for making meals were observed. Medications will be stored in a locked cupboard, sharp knives stored in a locked drawer and dish soap stored in the locked cabinet beneath the kitchen sink. Sufficient non-perishable foods for a minimum of 7 days were observed on the premises. Perishable Page 2 foods for a minimum of 2 days will be purchased and maintained on the premises prior to accepting the first resident The only fire extinguisher, purchased on 3/11/25 is mounted in the dining room. All three bedrooms were observed with 2 twin beds, 2 night stands, 2 lamps, 2 chairs and a built in closet. Bedroom #3 has a 4 drawer dresser. Window dressing were observed on the window and sliding glass doors. An extra curtain panel on the sliding glass door is needed in bedroom #2 for privacy. All the required bed linens and a pillow was observed on the beds. Extra set of linens and blankets and 13 sets of towels were observed in the cupboard located in the living room. Hygiene products, cleaning solution, laundry detergent were observed in the locked closet located in the living room. Little flash rights were observed on the night stands night light was observed in the hallway. The laundry closet located by the bedroom #1 was observed with a washer and dryer. A first aid kit and first aid manual was observed. The first aid kit needs a tweezer. The hardwired smoke alarms located inside the 3 bedrooms and the only combination smoke/carbon monoxide detector located in the hallway were tested and were operational. The required postings were observed. A laptop was observed for resident use The private bathroom located inside bedroom #2 was observed in a walk-in shower, a toilet, a bath tub, and a single sink. A slip resistant mat and grab bars were observed in the shower and behind the toilet. Grab bar is needed for the bath tub. Water temperature was tested and read 112.1 degrees Fahrenheit The common bathroom was observed with a walk-in shower, a toilet and a sink. A slip resistant mat and grab bars were observed in the shower and behind the toilet. The water temperature was tested and read 111.1 degrees Fahrenheit. The back and front yard was toured. The back has a covered patio with table and plenty of chairs for resident activities. Trash cans were observed to be tightly sealed along the garage. Page 3. The back and front yard was observed to be clean and well maintained. The garage was toured and had some items stored inside. However, the garage will be primarily used for parking. The following needs to be corrected prior to licensure: dressers are needed in bedroom #1 and #2 a tweezer needs to be placed in the first aid kit. a grab bar needs to added for the bath tub in the private bathroom an extra curtain panel needs to added in bedroom #2 for privacy The following will need to be completed upon licensure: purchase general liability insurance with limits of $1 million per occurrence and $3 million total annual aggregate. purchase perishable foods for a minimum of 2 days prior to accepting the first resident create files for residents, staff and volunteers Component III was conducted with Mane Gevorgyan, Applicant during this visit. The Applicant will notify LPA Yee once the corrections have been completed. Exit interview was conducted.the state’s words, verbatim · CDSS document, May 29, 2025