Mary's Chateau Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced required one year visit to the above facility. The LPA arrived at 9:57AM and met with Administrator Mary Petikyan. Entrance interview conducted. Beginning at 10:16AM, the LPA 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: COMMON AREAS: The living room and dining room furniture were observed to be in good condition. The facility maintained a comfortable temperature throughout the visit. There was sufficient space to accommodate both indoor and outdoor activities. Nightlights were observed throughout the common areas. All required postings were posted near the entrance of the facility. KITCHEN: Knives were stored in a locked kitchen drawer. Cleaning supplies were observed locked under the sink. The supply of nonperishable and perishable food was adequate. Food in the refrigerator and freezer were of good quality and labeled with dates. Appliances in the kitchen were clean and operational. A supply of emergency food was observed. Report Continued on LIC 809-C BEDROOMS/BATHROOMS: The facility had seven (7) bedrooms: six (6) private resident rooms and one (1) office/staff room. Bedrooms #3, #6, and the office/staff room have direct exits to the outside with Bedroom #6 approved for one (1) bedridden resident. Bedroom #1 had a screened and inoperable fireplace. Bedrooms contained required furniture and had sufficient lighting with ample space for easy passage. Extra supply of linens was stored in the hallway closet. There were five (5) bathrooms: three (3) private resident bathrooms and two (2) shared common bathrooms. Each bathroom contained non-slip mats, grab bars, paper products, and soap. One (1) shared bathroom contained a laundry closet that was secured with machines in operable condition. Hot water temperature was tested and measured between 101.8 degrees F and 110.5 degrees F. The LPA advised raising the water temperature slightly. OUTDOOR AREA: The exterior passageways were clean and clear of any obstructions. There was an area at the back of the house with tables and chairs where residents can sit. The outdoor space is properly gated. There were no bodies of water on the premises at the present time. There was one (1) emergency exit that led to the front yard which contained a remote operated driveway gate and a self-latching door gate for everyday usage. The premises had a locked garage that was used as facility storage and contained extra food with a refrigerator and emergency water. RECORDS: Record review began at 10:43AM. Resident records were reviewed for, but not limited to care plans, physician’s reports, admissions agreement, and 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. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly with the last documented drill on 07/17/2026. Fire extinguishers were observed throughout the facility and were last purchased on 05/01/2026. Combination smoke and carbon monoxide detectors and fire doors were tested at 11:02AM and were operational. MEDICATIONS: Medication review began at 11:04AM. Medications were centrally stored and kept inaccessible in the staff room/office. 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. No errors observed during the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 9, 2026

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced post-licensing visit to the above facility. At 11:26AM, the LPA met with the Administrator Mary Petikyan. Entrance interview conducted. Beginning at 11:48AM, the LPA 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: Knives were stored in a locked kitchen drawer. Cleaning supplies were observed locked under the sink. The supply of nonperishable and perishable food was adequate. Food in the refrigerator and freezer were of good quality and labeled with dates. Appliances in the kitchen were clean and operational. BEDROOMS/BATHROOMS: The facility had seven (7) bedrooms: six (6) private resident rooms and one (1) staff room. Bedrooms #3, #6, and the staff room have direct exits to the outside with Bedroom #6 approved for one (1) bedridden resident. Bedroom #1 had a screened and inoperable fireplace. Bedrooms contained required furniture and had sufficient lighting with ample space for easy passage. Extra supply of linens was stored in the hallway closet. There were five (5) bathrooms: three (3) private resident bathrooms and two (2) shared common bathrooms. Each bathroom contained non-slip mats, grab bars, paper products, and soap. One (1) shared bathroom contained a laundry closet that was secured with machines in operable condition. Hot water temperature was tested and measured between 107.6 degrees F and 120.3 degrees F. Report Continued on LIC 809-C COMMON AREAS: The living room and dining room furniture were observed to be in good condition. The facility maintained a comfortable temperature throughout the visit. There was sufficient space to accommodate both indoor and outdoor activities. Nightlights were observed throughout the common areas. All required postings were posted near the entrance of the facility. OUTDOOR AREA: The exterior passageways were clean and clear of any obstructions. There were two (2) areas at the back of the house with tables and chairs where residents can sit. The outdoor space is property gated. There were no bodies of water on the premises at the present time. There was one (1) emergency exit that led to the front yard which contained a remote operated driveway gate and a self-latching door gate for everyday usage. The premises had a locked garage that was used as facility storage and contained extra food with a refrigerator and emergency food and water. RECORDS: Record review began at 12:22PM. Resident records were reviewed for, but not limited to care plans, physician’s report, admissions agreement, and consent forms. All records were in order. The LPA discussed ensuring that all resident documents are signed. The Administrator agreed and stated there was a delay with the residents’ families. 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. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today’s visit, the LPA reviewed the facility’s infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. Emergency disaster drills are conducted quarterly with the last documented drill on 10/03/2025 and the next drill planned for this month. Fire extinguishers were observed throughout the facility and last purchased on 04/24/2025. Combination smoke and carbon monoxide detectors and fire doors were tested at 2:04PM and were operational. Due to unforeseen circumstances, the LPA will return at a later date to conduct the medication review. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Quoc Huynh conducted an announced pre-licensing visit to the above noted facility. At 9:37AM, the LPA met with applicants, Mary Petikyan and Manvel Minasyan. Entrance interview conducted. An application to operate a Residential Facility for the Elderly was submitted on 02/25/2025. A dementia program was included in the plan of operation. A Hospice Waiver for 4 (four) has been requested. The facility's fire clearance was approved on 07/01/2025 for one (1) bedridden and five (5) non-ambulatory, with a total capacity of six (6) residents. Component II orientation was completed on 07/31/2025. Component III was completed with the applicants during today's visit. The facility is a single-story home located in Sherman Oaks. Beginning at 9:41AM, a physical plant tour was conducted. The following was observed: KITCHEN: Knives were stored in a locked kitchen drawer. The supply of dishes, utensils, pots, pans and drinkware was adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable foods and emergency food supply was adequate. Cleaning supplies were stored in a locked cabinet under the kitchen sink. There were no pesticides or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and all appeared functional. Medications and files will be stored in a locked file cabinet located in the staff room. Report Continued on LIC 809-C BEDROOMS/BATHROOMS: The facility had seven (7) bedrooms: six (6) private resident rooms and one (1) staff room. Bedrooms #3, #6, and the staff room have direct exits to the outside with Bedroom #6 approved for one (1) bedridden resident. Bedroom #1 had a screened and inoperable fireplace. Resident rooms were set up with beds, nightstands, lamps, chairs, sufficient clothing storage and closet space. The beds were furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, and blanket (if needed). Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. All rooms were free of odors. All window screens were clean and maintained in good repair. There were five (5) bathrooms: three (3) private resident bathrooms and two (2) shared common bathrooms. The bathrooms had a shower with non-slip mats. One (1) hallway bathroom contained a laundry closet that was secured, and machines were in good condition. The toilet and shower had grab bars. The hot water temperature was tested and measured within the required range of 105*F to 120*F. COMMON AREAS: Common areas were appropriately furnished, and the lighting was adequate. There was a television, reading materials, and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. All ramps were secured and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included but not limited to flashlights. Nightlights were observed throughout the common areas. The facility had emergency food and water available. The facility has central heating and air conditioning to maintain rooms to a comfortable temperature. Report Continued on LIC 809-C At 10:05AM, the hardwired combination smoke and carbon monoxide detectors as well as fire doors were tested and functioned properly. The fire extinguishers throughout the facility were fully charged and purchased on 04/24/2025. The supply of extra bed and bath linens as well as personal hygiene items were adequate in the hallway closet. Extra incontinence supplies and other supplies were located outside in the locked garage storage. There was a functioning telephone on the premises. All required postings were posted near the entrance of the facility. First aid kit was observed to be complete, including a thermometer and a current version of a first aid manual. OUTDOOR AREA: The exterior passageways were clean and clear of any obstructions. There were two (2) areas at the back of the house with tables and chairs where residents can sit. The outdoor space is property gated. There were no bodies of water on the premises at the present time. There was one (1) emergency exit that led to the front yard which contained a remote operated driveway gate and a self-latching door gate for everyday usage. The premises had a locked garage that was used as facility storage and also contained extra food with a refrigerator. No corrections required. Exit interview conducted. A copy of the report was reviewed and provided. 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 the approval of your license.the state’s words, verbatim · CDSS document, Aug 20, 2025