Peaceful Living Board & Care

Type of visit: Case Management - Deficiencies

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced case management visit due to the deficiencies observed during a complaint visit to the facility. LPA Yee met with Arman Petrosyan, Administrator and the reason for today's visit was provided. During the complaint visit to the facility today, it was observed that the Administrator did not report the following incidents: allegation that staff hit Resident #1 facility did not report that Resident #1 was refusing medications. Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights were discussed and a copy was provided.the state’s words, verbatim · CDSS document, Sep 28, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(D) · Plan of correction due date: Oct 2, 2026

Reporting Requirements: Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events....Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents,.. Licensee did not report the alleged physical abuse of Resident #1 and missed medicationsthe state’s words, verbatim · CDSS document, Sep 28, 2026

Plan of correction: Licensee will read Section 87211 Reporting requirements and will submit a signed written statement that the section was read and understood and will be complied with at all times. Licensee will also submit an LIC624 for the alleged physical abuse and the missed medications by 10/2/26

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christine Yee conducted an announced Prelicensing and Component III visit to ensure that the home meets Title 22 requirements and met with Arman Petrosyan, Applicant/Administrator. The facility is an Accessory Dwelling Unit located behind the main house with the address of 14239 Valerio Street. The front house is also going through the application process under the name of Golden Bridge Board and Care. The ADU is a single storey home consisting of a living room, dining room, a kitchen, 3 resident bedrooms and 2 full bathrooms. The facility has a sprinkler system and is fire cleared for 4 NON-AMBULATORY and 2 BEDRIDDEN residents. Bedroom #1 is designated for Bedridden use. Today's visit was conducted using the CARE Inspection Tool and the following was observed: The living room is furnished with seating for 6 residents, a coffee table, a mounted television and a television stand that is use for storage of board games. the dining room is furnished with a table and 6 chairs. Located in the dining is the only fire extinguisher that was purchased on 2/28/26 The kitchen is furnished with a stove, refrigerator, microwave, a coffee maker and toaster. Sufficient dinner ware, utensils, coffee cups and dessert plates were observed. Pots and pans for cooking were observed. Medications and sharp knives are stored in a locked cabinet under the kitchen counter and the cleaning solutions are stored under the kitchen sink. Continued on LIC809-C Page 2. Perishable foods for a minimum of 2 days will be purchased prior to accepting the first resident and additional non-perishable foods for a minimum of 7 days need to be purchased. All three resident bedrooms are furnished with 2 twin beds, 2 chairs, 2 night stands, 2 lamps, and built in closets. Dressers meeting Title 22 requirements need to be purchased. The required bed linens and pillows were observed on all the beds and extra linens were observed in the closet. Curtains for privacy were observed Sufficient bath towels, hand towels and 3 face towels were observed. Additional face towels need to be purchased in quantities to allow for changing. The common bathroom and private bathroom located inside bedroom #1 is equipped with a walk in show, grab bars, slip resistant mat, a toilet and a single sink vanity. The private bathroom also has a shower chair. The water temperature in the private bathroom was tested and read 110.9 degrees and the water temperature in the common bathroom read 115.4 degrees Fahrenheit. Hygiene products such as shampoos, conditioners, soap, tooth brushes, toothpaste were observed locked in the common bathroom cabinet under the sink. The laundry closet located in the resident hallway contains a washer and dryer and detergents are locked in a cabinet. The smoke detectors located in the resident bedrooms, hallway and the combination smoke/carbon monoxide detector in the living room were tested and were operational. A first aid kit containing the required items and the first aid manual were observed The auditory devices mounted on the outside exiting doors located in bedroom #1, back door and front door were tested an were operational. Per tour of the backyard, a covered patio with a rattan love seat and 2 rattan arm chairs were observed. Two extra chairs are needed to accommodate 6 residents. The trash cans stored in front of the property were observed. Overall, the backyard and front yard were observed to be clean. Pieces of wood and plastic piping were observed along the left side of the home. Per Applicant, they are still working on the front house and the items will be removed. Continued on LIC809-C Page 3. The following deficiencies need to be addressed: additional face towels need to be purchased. dressers meeting Title 22 requirements need to be purchased for all 3 bedrooms additional non-perishable foods to meet the 7 day requirement needs to be purchased. 2 additional chairs are needed in the back patio. review and update the Emergency Disaster Preparedness Plan review and update the Infection Control Plan post visiting hours The following needs to be completed upon licensure: Perishable foods for a minimum of 2 days will be purchased prior to accepting the first resident. Purchase General Liability Insurance that meets Title 22 requirements Create files for staff and residents with the required documents. Component III was also conducted with Arman Petrosyan, Applicant/Administrator on today's visit. Applicant will notify LPA Yee once the corrections have been completed by no later than 5/22/26. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 13, 2026

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): Method: Telephone call with CAB COMP II Participants: Petrosyan, Arman On 3/13/2026, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. 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. 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, Mar 13, 2026