Abbey Road Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan met with Administrator Marine Karapetian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 9:38 AM and the following was noted: There is only one entrance being utilized at the facility, the front main entrance door. Screening area is located immediately upon entrance. The facility had submitted and approved Mitigation and Infection plan. The facility is a single storey building with shared and private bedrooms and bathrooms. Exit signal alarms were tested and at 10:05 AM and observed to be operational. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and interconnected and back up tests are done in house on a regular basis. The facility is equipped with sprinkler system which was last tested on 02/05/26 and valid until 01/31/27. Fire Alarm test was also performed also on 02/05/26. Fire extinguishers are located all throughout the facility and were last serviced on 02/11/26. Fire Drill was last conducted on 08/05/26. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. (continued to LIC 809-C) (continued from LIC 9099) Bedrooms: The resident bedrooms were properly furnished with one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. There are four (4) common shower rooms in the facility, all observed to be clean and in good repair. Hot water was measured in random bathroom at the range of 105.4°F to 110.1°F and observed to be within the required limit. Common Areas: These includes the living room, dining room and outdoor areas. Facility common areas appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Medications were observed to be stored in designated Medication room. The Medication room was observed to be locked at the time of visit. There are two (2) sets of first aid kit in the Medication room. Resident/Staff File Review: LPA reviewed records of five (5) random residents and five (5) staff. Resident and staff records appeared to be complete and updated. Laundry room is located in hallway no. 2 and observed to be locked during visit. There is no immediate health and safety hazard during this visit. Exit interview conducted. Copy of this report issued,the state’s words, verbatim · CDSS document, Aug 11, 2026

Allegation investigated: Staff sexually abused resident.

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint to this facility to further investigate the above allegation. LPA met with Administrator Marine Karapetyan and explained the reason for the visit. LPA conducted a physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 10:11 AM, reviewed records between 10:15 AM to 11:15 AM and interviewed residents and staff between 11:30 to 1:30 PM. Regarding the allegation that Staff sexually abused resident, it was alleged that R1 was touched by a staff on R1's private parts. LPA's interview with R1 today at 1:20 PM revealed that the alleged perpetrator was not a staff of the facility but that of Home Health agency who provide services to residents. LPA's phone interview with Home Health staff confirmed that that Staff #1 (S1) is their employee and only visits the facility during weekends. LPA's interview with the Administrator today at 11:34 AM, confirmed that S1 was employed by Home Health Agency and assigned to three (3) residents but not to R1 and was not aware of the alleged incident until an LPA came to investigate. (continued on LIC 9099) Unsubstantiated (continued from LIC 9099) The Administrator reported the alleged incident upon learning to the Department, the Home Health Agency, Long Term Care Ombudsman (LTCO) and local police. Further, the Administrator did not receive any report from any staff regarding the alleged incidents at any time. LPA's interview with four (4) staff, two (2) night shift and two (2) morning shift revealed that they were not aware, witnessed nor received any report that anyone made inappropriate advances to anyone at the facility during their shift. Based on the information gathered during this and prior visit, this allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 14, 2026 · control 31-AS-20260424124136

Allegation investigated: Staff did not keep the facility free of pests Staff did not provide proper food service to residents in care

Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced initial complaint visit to investigate the above stated allegations. Upon arrival, LPA was greeted by the receptionist and met with the Assistant Administrator Lily Mantizyanand, shortly thereafter, the Administrator Marine Karapetian. LPA explained the purpose of the visit and requested copies of pertinent documents, including the Staff Roster, Resident Roster, Food Menus, and other records relevant to the investigation. Today's investigation consisted of interviews with five staff members and five residents. Regarding the allegation: Staff did not keep the facility free of pests It is alleged that the facility was infested with roaches and that roaches had been observed climbing on tables. The Administrator denied the allegation and stated that the facility contracts with a pest control company that provides services at least once per month and on an as-needed basis. The Administrator explained that these services are preventative in nature and not the result of any known pest infestation within the facility. (Continue on 9099C) Unsubstantiated LPA interviewed five staff members and four residents, none of whom corroborated the allegation. LPA also conducted a physical plant inspection, including Rooms #405, #407, #101, #106, and #108, as well as the common bathrooms, dining room, kitchen, kitchen pantry, and medication room. No insects or signs of pest activity were observed during the inspection. The Administrator provided copies of the pest control company's invoices for the previous three service visits. Based on interviews, observations, and documentation reviewed, there was insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding the allegation: Staff did not provide proper food service to residents in care It is alleged that meals served to residents consisted only of salad and bread with mayonnaise or, at times, plain bread without additional food items. Interview with the Administrator denied the allegation and stated that the facility's dietitian develops monthly menus to ensure that residents receive balanced and nutritious meals that meet their dietary needs. The Administrator provided copies of the facility's menus for the previous three weeks. LPA reviewed the menus and observed that they reflected balanced meals consisting of a variety of food groups. LPA reviewed the dietitian's monthly food service inspection report dated 05/28/26, which indicated no deficiencies. Additionally, interviews conducted with five residents and five staff members did not corroborate the allegation. At approximately 1:00 PM, LPA observed the lunch service. Residents were served chicken quesadillas, French fries, green pea soup, salad, fruit, and juice. Based on interviews, observations, and records reviewed, there was insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted; copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 4, 2026 · control 31-AS-20260528114046

Allegation investigated: Facility did not provide resident’s records to authorized representatives.

Licensing Program Analyst (LPA) Jose Tan conducted an unnanounced initial complaint visit at this facility to investigate the above allegation. LPA met with Marine Karapetian and explained the reason for the visit. LPA conducted a physical plant tour at 9:52 AM, requested copy of facility documents relevant to the investigation at 10:12 AM, reviewed records between 10:30 AM to 11:30 AM and interviewed staff between 11:30 to 1:00 PM. Regarding the allegation that Facility did not provide resident’s records to authorized representatives. It was alleged that the facility failed to provide the requested documents. LPA's record review revealed that the RP's letter clearly stated that "contact our office within two (2) working days, to arrange the photocopying of the entirety of the resident records" LPA's interview with the RP at 10:31 AM today revealed that they don't send anyone to make a copy to the facility or anywhere and requesting electronic copy only. LPA's interview with the Administrator today at 11:49 AM, revealed that they have the file on storage and will be available for them to copy at anytime, however, it may take a lot of effort on their staff to scan documents and send it to them electronically. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's phone interview with the Licensee Representative (LR) at 12:03 PM, revealed that the LR did not refuse to provide the documents but explained to the RP that electronic copy will take a lot of working hours to the staff. Based on the information gathered during this visit, this allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 19, 2026 · control 31-AS-20260515170122

Allegation investigated: Staff do not ensure resident's personal belongings are safeguarded

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Administrator Marine Karapetian and explained the reason for the visit. LPA conducted physical plant tour at 9:30 AM, requested copies of facility documents relevant to the investigation at 10:00 AM and interviewed staff and residents between 10:00 AM to 1:00 PM. Regarding the allegation that Staff do not ensure resident's personal belongings are safeguarded, it was alleged that Resident #1 (R1)'s papers, food, money and a blanket were stolen right of R1's bed. LPA's interview with R1 today at 10:05 AM revealed that R1 was unable to specifically tell the amount and identify supposedly missing items and when exactly did it happen. R1 stated that R1 did not witness the stealing but only suspected. LPA's interview with R1's roommate at around 10:42 AM revealed that Resident #2 (R2) did not witness anyone, resident or staff, taking anything from R1's belongings, staff just clean the room and leave and no other resident R2 came to their room and took anything from R1. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's record review at around 11:18 AM revealed that R1 did not declare on form LIC 621 (Resident Personal Property and Valuables) any of the alleged missing items. LPA's interview with six (6) residents or more than ten percent (10%) of the current census, revealed that six (6) out of six (6) residents interviewed did not witness or experience personal belongings being taken or stolen by any staff or resident of the facility. Based on the information gathered during this visit, this allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 8, 2026 · control 31-AS-20260406082943

Allegation investigated: Unlawful eviction

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Administrator Marine Karapetian and explained the reason for the visit. LPA conducted a physical plant tour at 10:03 AM, requested copies of facility documents relevant to the investigation at 10:28AM, reviewed records between 10:30 AM to 11:30 AM and interviewed staff between 11:30 AM to 1:00 PM. Regarding the allegation of Unlawful eviction, it was alleged that when Resident #1 (R1) was hospitalized, the facility refused to take R1 back. LPA records review today between 10:30 AM and 11:30 AM, revealed that R1 was issued an eviction notice way back in March 2025 for non-payment and multiple violation of house rules but was rescinded due to ALW case worker was working actively to place R1 somewhere else that may meet R1's needs. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) On ALW's case worker continuous effort, R1 was almost placed twice to a different facility but it was R1 who refused to move to potential placement until 09/22/25 where R1 was successfully placed by the ALW case worker in another facility that accommodated R1. LPA's interview with the Administrator today also revealed that it was the ALW case worker who suggested that R1 remain at the hospital until they found placement because R1 will continue to refuse placement to another place if R1 get back to the facility. Therefore, based on the information gathered during this and prior visit, this allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 24, 2026 · control 31-AS-20250908113632

Allegation investigated: Staff does not ensure to provide communication resources to resident. Staff did not conduct a proper assessment to resident during pre-admissions.

Licensing Program Analysts (LPAs) Jose Tan and Michael Cava conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPAs met with Administrator Marine Karapetian and explained the reason for the visit. LPAs conducted a physical plant tour at 11:30 AM, requested copies of facility documents relevant to the investigation at 12:00 PM, reviewed records between 12:00 PM to 1:00 PM and interviewed staff and residents between 1:00 PM to 1:45 PM. Regarding the allegation that Staff do not ensure to provide communication resources to resident, it was alleged that Resident #1 (R1) had no telecommunication of any kind exist at the facility. LPAs' interview with R1 today at around 11:48 AM, revealed that that the same issues were presented by R1 on R1's prior complaint dated 02/18/25 (cc no.: 31-AS-20250218003240). LPA's record review today between 12:00 PM to 1:00 PM also revealed that it was R1 who refused to wear the hearing device implant and refused to pay subscription to R1's three (3) cellular phone units (please see report dated 07/08/25) and the Administrator tried to assist R1 to obtain what R1 needed to communicate. Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff did not conduct a proper assessment to resident during pre-admissions, it was alleged that R1 was placed at the facility, without any physical or assessment nor questions by a doctor or Nurse. LPAs' record review between 12:00 PM to 1:00 PM revealed that R1 has a preplacement appraisal information (LIC 603) on file dated and signed by R1 on 03/15/2022, appraisal needs and services plan (LIC 625) signed and dated by R1 on 01/04/23, refused to sign on 10/07/24, signed and dated on 10/07/25 and signed and dated on 02/10/26. R1 also had a physician's report dated 11/03/22, 10/07/24 and 10/01/25. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 11, 2026 · control 31-AS-20260202173809

Allegation investigated: Staff handled resident in a rough manner.

On 2/02/2026 at approximately 9:20 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by the Administrator, Marine Karapetian and stated the reason for their visit. To investigate the allegation(s), at approximately 09:30 AM, LPA conducted a physical plant tour. By 10:00 AM, LPA requested relevant documentation. From 10:00 AM to 11:30 AM, LPA attempted interviews with seven (7) residents (R1-R7), four (4) staff members (S1-S4) and conducted record review. (Continue to LIC 9099-C) Unsubstantiated Regarding the allegation: Staff handled resident in a rough manner. It was alleged that a staff member (S2) assisted R1 in a rough manner. To investigate the allegation, LPA attempted interviews with seven (7) residents and four (4) staff members. LPA’s interview with six (6) residents confirmed that staff do not hurt them while assisting them with their Activities of Daily Living (ADLS) (Let it be noted ADLs consist of but not limited to: changing, showering, grooming and transferring needs). LPA attempted to interview R1, but they no longer reside at the facility. LPA’s interviews with three (3) staff members confirmed that they do not hurt residents while assisting them with their ADLs nor have witnessed others to do so. LPA attempted to interview S2, but they were not present during their visit. LPA’s record review of the facility’s Unusual Injury/Incident Reports (SIRs) dated 9/29/2025 revealed the facility self-reported an incident involving R1 and S2 to Community Care Licensing Division (CCLD) and other corresponding agencies. Further review of the documentation did not reveal there to be any serious or minor bodily injuries notated. During LPA’s physical plant tour, LPA observed staff members assisting residents. LPA did not observe residents to be in distressed or being treated inappropriately by staff. Based on interviews, record review and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 2, 2026 · control 31-AS-20251003161748

Allegation investigated: Resident sustained fracture while in care. Staff does not keep facility free from pests Staff does not provide a comfortable room temperature for resident Staff unable to communicate residents needs due to language barrier Staff stole resident’s money

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Administrator Marine Karapetyan and explained the reason for the visit LPA conducted a physical plant tour at 9:18 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed records between 10:00 AM to 11:00 and interviewed staff between 11:00 AM and 1:00 PM. Regarding the allegations that Resident sustained fracture while in care, it was alleged that Resident #1 (R1) fell and was unable to move the next day due to neck fracture. LPA’s record review between 10:00 AM to 11:00 AM, revealed that R2 was the same resident the reporting party (RP) reported on prior complaint with complaint control number 31-AS-20250617131313 (please see report dated 06/18/25) wherein RP reported that the facility did not immediately call 911 during a fall, this allegation was unsubstantiated as R2 did not fall and was hospitalized for shortness of breath (SOB) and it was the facility nurse who observed R2 having an SOB and called 911 immediately and sent to the hospital. Unsubstantiated Regarding the allegation that Staff does not keep facility free from pests, it was alleged that there are cockroaches at the facility, LPA’s observation during this and prior visits revealed that LPA did not observe any cockroaches in random bedrooms and common areas of the facility. LPA’s interview with six (6) residents or 10% of the current census today between 11:00 AM and 1:00 PM revealed that six (6) out of six (6) residents interviewed did not observe any cockroaches in their room or anywhere else in the facility. LPA’s record review also revealed that the facility has a contracted pest control company that visits the facility regularly every month and as needed if there is any reported sighting of pests. Regarding the allegation that staff do not provide a comfortable room temperature for resident, it was alleged that staff do not adjust the room temperature in R1's room. LPA observation during visit revealed that the wall temperature at the facility was set at 75°F. LPA’s interview with the Administrator revealed that every room has their own controller but temperature is controlled by clusters (3-4 rooms per cluster) and did not receive any complaint from any resident about their room temperature because if they did, they would have been adjusted the temperature in their cluster easily. LPA’s interview with six (6) residents or 10% of the current census today between 11:00 AM and 1:00 PM revealed that six (6) out of six (6) residents interviewed did not have any problem with the temperature in their respective rooms. Regarding the allegation that Staff are unable to communicate residents needs due to language barrier, it was alleged that there is a language barrier between staff and residents. LPA’s observation during this and prior visits, during LPA's interview with staff, some staff are bilingual but they spoke conversational English and easily comprehensible. LPA’s interview with four (4) English only speaking residents and two (2) bilingual residents revealed that all residents interviewed did not have any problem communicating with the staff. Regarding the allegation that Staff stole resident’s money, it was alleged that a staff stole $900 dollars from Resident #2 (R2)’s wallet when R2 was sleeping. LPA’s record review between 10:00 AM to 11:00 AM revealed that R2 the same allegation on prior complaint with cc no.: 31-AS-20250617131313 (please see report dated 10/07/25) wherein the police were called and unable to establish the veracity of R1’s claim and was therefore unsubstantiated. LPA's record review also revealed that there was no money given to the facility for safekeeping and per the Administrator, this was the pattern of R1 whenever R1 gets invoiced for R1’s rent at the facility. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 31-AS-20250902101927

Allegation investigated: Licensee did not follow reporting requirements

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Administrator Marine Karapetian and explained the reason for the visit. LPA conducted physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed record between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that Licensee did not follow reporting requirements, it was alleged that Resident #1 (R1) was abused by a staff and reported to the facility in August 2025 but the Administrator has not completed a SOC341 and reported it to the Ombudsman's office. LPA's record review today between 10:00 AM to 11:00 AM revealed that the facility self-reported an alleged incident on 09/29/25, wherein Staff #1 (S1) relocated the kidney of R1 while changing R1's diaper about a month ago. A complaint was also filed against the facility for the alleged abuse under complaint control number 31-AS-20251003161748 dated 10/03/25. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Further review also revealed that attached to the complaint is an SOC 341 which was cross reported to Long Term Care Ombudsman (LTCO) and Local Police Department. Further review also revealed that there was no serious or minor injury reported during the alleged incident and no reasonable appearance and/or resemblance of physical abuse or harm to the R1. Based on the information gathered during this visit, this allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Nov 18, 2025 · control 31-AS-20251112142157

Allegation investigated: Staff did not provide adequate supervision, resulting in resident hitting another resident with an object Staff did not safeguard resident's belongings Staff spoke inappropriately to resident Staff withheld mail from resident

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Marine Karapetian and explained the reason for the visit. LPA conducted a physical plant tour at 9:52 AM, requested copies of facility documents relevant to the investigation at 10:12 AM, reviewed records between 10:15 AM to 11:15 AM and interviewed staff and residents between 11:15 AM to 1:00 PM. Regarding the allegation that Staff did not provide adequate supervision, resulting in resident hitting another resident with an object, it was alleged that Resident #2 (R2) hit Resident #3 (R3) in the face with a shoe. LPA's interview with R3 on 06/18/27 revealed that R3 was hit by R2 with a paper in the body inside their room and did not report it to anyone. LPA's record review revealed that both R2 and R3 are independent. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff did not safeguard resident's belongings, it was alleged that R1's $900 was stolen out of R1's wallet the first weekend of April and R1's roommate Resident #2 (R2) stole R1's Visa card and used it at Walgreen's. LPA's interview with the administrator on 06/18/25 revealed that they reported R1's claim to the police per the facility's theft and loss policy and the police investigated, the police was not able to establish the veracity of R1's claim about the $900 but was able to get the video footage of R1 using own card at Walgreen's. Further interview with the administrator revealed that this always happened to R1 almost every month when the administrator issued R1 an invoice for monthly rent, which R1's hasn't paid for a few months now. Regarding the allegation that Staff spoke inappropriately to residents, it was alleged that R1 was called a "liar" and that Staff #1 (S1) yells. LPA's interview with residents between 11:15 AM to 1:00 PM today, revealed that seven (7) out of seven (7) did not experience being yelled at by S1 or spoken inappropriately by any other staff nor witnessed anyone being yelled at by S1 or spoken inappropriately. Regarding the allegation that Staff withheld mail from resident, it was alleged that staff are withholding mail from R1. LPA's interview with staff revealed that all mail is received in the Administrator's office and recipient residents are called to get their mails, if resident is unable to, care staff deliver the mail to the resident on the same day or the day after. LPA's interview with seven (7) residents or more than 10% of current census revealed that all of them stated that they received their mail regularly all the time. LPA's interview with two (2) care staff and the receptionist who received the mail revealed that they do not withhold any one's mail and/or packages. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 7, 2025 · control 31-AS-20250617131313

Allegation investigated: Staff did not provide resident with an itemized bill Staff did not provide resident with a copy of Admission Agreement Staff did ensure resident from using methamphetamine on premises of facility

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to investigate the above allegations, LPA met with Administrator Marine Karapetian and explained the reason for the visit. LPA conducted a physical plant tour at 9:40 AM, requested copies of facility documents relevant to the investigation at 10:05 AM, reviewed records between 10:05 AM to 11:05 AM and interviewed residents and staff between 11:15 AM to 1:00 PM. Regarding the allegation that Staff did not provide resident with an itemized bill, it was alleged that Resident #1 (R1) was requesting Itemized bill from the administrator but had not been given one. LPA's record review today between 10:05 AM to 11:05 AM revealed that R1 is a Social Security Supplemental Income (SSI) recipient and pays SSI rate to the facility and there is no itemized bill because the services provided to R1 and all other SSI recipients are enumerated on their Admission Agreement. LPA's interview with the administrator today at 11:19 AM, revealed that R1 is under the Assisted Living Waiver (ALW) program Level 4 (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff did not provide resident with a copy of Admission Agreement, it was alleged that R1 has been requesting his admission agreement but was not provided one. LPA's record review today revealed that R1 was admitted on 04/24/25 and signed the admission agreement on the same day. LPA's interview with R1 also revealed that R1 had received a copy of R1's admission agreement. Further interview with R1 also revealed that R1 is self-responsible and can manage own cash resources. Regarding the allegation that Staff did ensure resident from using methamphetamine on premises of facility, it was alleged that the reporting party (RP) saw a man smoking meth in a grassy area just outside the facility, the RP remarked that the area had a strong smell of meth. LPA made a reasonable effort to contact the RP to no avail. LPA's interview with seven (7) residents or more than 10% of the current census today between 11:15 AM to 1:00 PM, revealed that seven (7) out of seven (7) residents interviewed did not know any resident who is using illegal drugs nor witnessed anyone using drug while inside the facility. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 16, 2025 · control 31-AS-20250609155856

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA Jose Tan met with Administrator Marine Karapetian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 9:44 AM and the following was noted: There is only one entrance being utilized at the facility, the front main entrance door. Screening area is located immediately upon entrance. There is also a sign in sheet, hand sanitizer, gloves and masks available. The facility had submitted and approved Mitigation and Infection plan. The facility is a single storey building with shared and private bedrooms and bathrooms. Exit signal alarms were tested and at 10:05 AM and observed to be operational. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and interconnected and back up tests are done in house on a regular basis. The facility is equipped with sprinkler system which was last tested on 02/09/24 and valid until 01/31/27. Fire extinguishers are located all throughout the facility and were last serviced on 02/05/25. Fire Drill was last conducted on 08/05/25.. (continued to LIC 809-C) (continued from LIC 9099) Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Bedrooms: The resident bedrooms were properly furnished with one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. There are four (4) common shower rooms in the facility, all observed to be clean and in good repair. Hot water was measured in random bathroom at the range of 110.5°F to 118.2°F and observed to be within the required limit. Common Areas: These includes the living room, dining room and outdoor areas. Facility common areas appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Medications were observed to be stored in designated Medication room. The Medication room was observed to be locked at the time of visit. There are two (2) sets of first aid kit in the Medication room. Resident/Staff File Review: LPA reviewed records of six (6) random residents and five (5) staff. Resident and staff records appeared to be complete and updated. Laundry room located in the hallway no, 2 observed to be locked during visit. There is no immediate health and safety hazard during this visit. Exit interview conducted. Copy of this report issued,the state’s words, verbatim · CDSS document, Aug 28, 2025

Allegation investigated: Facility staff are illegally locking exit doors Facility fire alarms are in disrepair

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Administrator Marine Karapetian and explained the reason for the visit. LPA conducted a physical plant tour at 9:22 AM, requested copies of facility documents relevant to the investigation at 10:00 AM and interviewed staff and residents between 10:15 AM to 1:00 PM. Regarding the allegation that Facility staff are illegally locking exit doors, it was alleged that the administrator has locked the back exit doors. LPA’s observation during physical plant tour on 05/06/25 at 10:05 AM and today at 9:22 AM revealed that the door at the back is for emergency exit only and was not locked but a one-way door with egress only and no ingress as it is for emergency use only. LPA's phone interview with Los Angeles Fire Department (LAFD) Inspectors also revealed that the former system which only responds to fire, is not acceptable so the facility removed the fire door system and installed an egress only emergency exit door which the LAFD Inspectors allow. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that fire alarms keep going off, it was alleged that the fire alarms at the back exit door keep on going off. LPA’s observation during physical plant tour on 05/06/25 at 10:05 AM and today at 9:22 AM revealed that the emergency exit door alarm is working properly and hardwire connected, further observation revealed that it only sounds off whenever a person goes out through this emergency exit door. LPA's interview with the administrator today at 11:00 AM revealed that the door is being used by residents as a short cut to go out going to the main gate and every time they pass that door, the alarm sounds off. LPA's interview with six (6) residents or 10% of the current census revealed that six (6) out of six (6) residents interviewed revealed that no one among them noticed any kind of alarm that is going off at the facility aside from the usual alarm when opening the emergency exit door. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 23, 2025 · control 31-AS-20250430163304

Allegation investigated: Staff do not ensure that the resident has means to communicate Staff do not properly assist a resident with medical testing and appointments

This is an amendment of report dated 04/09/25 to rectify typographical errors, No change in findings. Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Administrator Marine Karapetyan and explained the reason for the visit. LPA conducted a physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that Staff do not ensure that the resident have means to communicate, it was alleged that Resident #1 (R1) is deaf and has no phone to use. LPA's observation on the prior visit on 04/09/25 revealed that R1 had a phone provided by R1's Adult Day Health Center ADHC) but was not set up properly so it wasn't working. LPA called the administrator and admitted that the Administrator was not aware that R1 has this landline phone. The administrator called the ADHC and the technician of the phone only to find out that the landline phone needed a subscription before it could work but R1 is unwilling to pay the subscription fee. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's observation during today's visit revealed that R1 had three (3) cellular phone units in R1's possession but none seems to be working due to unpaid subscription to provider. LPA’s records review also revealed that R1 had a cochlear implant which was lost prior to admission but the administrator successfully obtained a replacement in April 2023 and had it implanted to R1, but R1 removed it despite the instruction that it had to be connected to R1's brain for a minimum of 24 hours to successfully adapt and work properly but R1 did not abide by instruction and eventually broke and lost the implant again. The administrator worked again to obtain another set of implant for R1 and it was shipped from the provider company on 04/01/25 and was received directly by R1, with the condition however that R1 return the old broken implant to the provider company, record review revealed that R1 refused to return the old broken implant and now was billed for $7,995.00 for the new implant. Regarding the allegation that Staff do not properly assist a resident with medical testing and appointments, it was alleged that the staff do not assist R1 and that they have ordered testing for R1 that was not done. LPA's record review today revealed that R1 had numerous doctor's appointments in different disciplines from dental to Neurology to Psychiatric appointment, including an Audiology appointment for testing on 03/28/25. Further facility records review, specifically medical appointment log, also revealed that the staff arranged R1's transportation during these appointments including hearing testing of R1. Based on the information gathered during this and prior visits, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Jul 8, 2025 · control 31-AS-20250218003240

Allegation investigated: Illegal eviction Staff did not ensure that resident's dietary needs were met Staff did not seek timely medical attention for resident

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Administrator Marine Karapetyan and explained the reason for the visit. LPA conducted physical plant tour at 9:39 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation of Illegal eviction, it was alleged that the Administrator is threatening Resident #1 (R1) with eviction. LPA's record review between 11:00 AM to 12:00 PM revealed that R1 was being evicted for non-payment and was issued an eviction letter on 04/25/25. LPA's interview with the administrator today at around 12:30 revealed that the administrator rescinded the eviction about a week later from issuance upon the intervention of the Assisted Living Waiver (ALW) staff with the verbal agreement that R1 will be relocated, R1 however still lives at the facility to date and not paying the right amount of rent every month. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff did not ensure that resident's dietary needs were met, it was alleged that dietary needs of R1 was not being met. LPA's record review today between 10:00 AM to 11:00 PM, revealed that R1 has only No Added Salt (NAS) dietary restriction on R1's diet and this was prominently displayed on the kitchen. LPA's interview with kitchen staff revealed that all residents with the dietary restriction is being provided to the kitchen and being updated regularly by the Administrator. Further interview also revealed that all the dietary restriction are being followed during preparation of their meals to abide by the said restriction with no exception. Regarding the allegation that Staff did not seek timely medical attention for resident, it was alleged that Resident #2 (R2) was allegedly saw by R1 "sitting on the floor with R2's back propped up against R2's dresser" and staff did not call 911 until the next day. LPA's record review revealed that R2 did not fall and was hospitalized on 06/06/25 for shortness of breath (SOB) due to R2's medical condition. LPA's interview with staff also revealed that it was the nurse who visited R2 during routine visit who observed R2 having an SOB and sent immediately to the hospital via 911. Further review also revealed that R2 is still at the hospital to date. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 18, 2025 · control 31-AS-20250617131313

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff neglect led to resident sustaining pressure injuries Staff did not meet resident's medical needs in a timely manner

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Marine Karapetyan and explained the reason for the visit. LPA conducted physical plant tour at 9:28 AM, requested copies of facility documents relevant to the investigation at 10:02 AM, reviewed records between 10:10 AM to 12:30 PM and interviewed staff between 12:30 AM to 1:30 PM. Regarding the allegation that Staff did not meet resident's medical needs in a timely manner, it was alleged that Resident #1 (R1) was transported to Southern California Hospital due to a possible infection of R1's foot and had to be treated for a serious foot infection. LPA's record review today between 10:10 AM to 12:30 PM revealed that R1 was admitted at the facility on 07/03/23 and was hospitalized on 02/09/24 and did not come back to the facility, during R1's stay at the facility R1 was hospitalized for various medical complaint nine (9) times from 07/06/23 to 02/09/24, aside from regular monthly check up at the facility by R1's Primary Care Physician (PCP). (continued on LIC 9099) Unsubstantiated (continued from LIC 9099) Further review also revealed that there are times that R1 refused regular medical checkup at the facility and was referred to a podiatrist to see R1's foot but refused to see the Podiatrist on 02/08/24, R1 was hospitalized the next day (02/09/24) for this reason. Being a non-medical facility, the facility sends R1 to hospital and inform R1's PCP for all of R1's medical concern on a regular basis. Regarding the allegation that Staff neglect led to resident sustaining pressure injuries, it was alleged that R1 was admitted to the hospital and had to be treated for bed sores on her buttock area. LPA's record review revealed that immediately prior to hospitalization, R1 was at the pain clinic for an outpatient consult. During this encounter, Clinic doctors did not notice any break or injury on R1's skin and was "unremarkable" during this visit. LPA's interview with three (3) care staff during this visit revealed that no one among the three (3) care staff noticed any break or injury on R1's buttocks or any pressure area on R1's skin. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 13, 2025 · control 31-AS-20241108102704

Allegation investigated: Staff are providing allergic foods to a resident Staff do not ensure a resident is properly fed while in care

This is an amendment of report dated 04/09/25 to rectify typographical errors, No change in findings. Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Marine Karapetian and explained the reason for the visit. LPA conducted a physical plant tour at 9:18 AM, requested copies of facility documents relevant to the investigation at 10:02 AM, reviewed records from 10:03 to 11:15 AM and interviewed staff and residents between 11:30 to 1:00 PM. Regarding the allegation that Staff are providing food to a resident that the resident is allergic to, it was alleged that Resident #1 (R1) was given food that R1 is allergic to. LPA’s record review today confirmed that R1 has food allergies. During LPA's physical plant tour however, LPA observed that R1's food allergy is prominently posted in the kitchen preparation area. LPA's interview with kitchen staff today at 12:34 PM revealed that they always prepare separate food for R1 and ensure that R1's food has none of the food that R1 has an allergy with. LPA observed during lunch that R1 was served with different food from the menu without the food R1 is allergic to. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff do not ensure a resident is properly fed while in care, it was alleged that R1 goes without eating for days and does not have alternative food to eat. LPA's observation during physical plant tour revealed that the facility has alternate food (sandwiches) in the refrigerator and LPA's interview with the kitchen staff confirmed that they always have alternate food all the time in case any resident wants one or to give during snacks. LPA's interview with R1 today at 12:23 PM revealed that R1 goes to Adult Day Health Care (ADHC) program almost every day from 6:35 AM to 1:30 PM and stated that R1 eats breakfast and lunch at the ADHC. Further, R1 also buys own food all the time. Three (3) staff interviewed on 02/20/25 confirmed that R1 buys their food all the time. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Apr 9, 2025 · control 31-AS-20250218003240

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Resident sustained multiple fractures while in care

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to deliver the findings for the above allegation. LPA met with staff Anush Karapetyan who called the Administrator Marine Karapetian and explained the reason for the visit. Ms. Karapetian designated the staff to sign the report. On 09/17/24, a complaint was received by the Woodland Hills Adult and Senior Care Regional Office. The complaint was referred to and accepted by Community Care Licensing Division’s Investigations Branch (IB) and assigned to IB investigator Christine Ferris. On 09/18/24 at 9:23 AM, LPA initiated the complaint visit. LPA interviewed staff and residents and obtained copies of the facility records relevant to the investigation. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) During the course of the investigation, Investigator Ferris interviewed the administrator, staff, and residents on different dates and times on 10/17/24 and 11/18/24. IB Investigator Ferris also reviewed hospital records on 11/12/24, Los Angeles Police Department (LAPD)’s records on 10/07/24 and 11/07/24. Regarding the allegation resident sustained multiple fractures while in care, it was alleged that due to staff neglect, Resident #1 (R1) was punched in the face by Resident #2 (R2) sustaining injury and fracture on R1’s face and hip fracture due to R1’s eventual fall. Investigator Ferris’ record review of LAPD’s report revealed that R2 was arrested immediately after the incident at the facility but upon receipt of the facility surveillance video footage of the incident, the Deputy District Attorney rejected to file a case against R2 due to lack of sufficient evidence and eventually released R2 back to the facility. Investigator Ferris’ and LPA’s review of the facility surveillance video footage revealed that R1 and Resident #3 (R3) were together around the corner of the facility along the hallway and upon seeing R2 walking towards them, R1 charged R2 and punched R2 in the face. R2 reacted by punching R1 back (in the face) causing R1 to fall to the ground. R2 then walked away while R3 stayed with R1 until staff arrived and called 911. LPA’s record review on 03/29/25 also revealed that R1 and R2 were able to perform their own Activities of Daily Living (ADL)s including but not limited to toileting, managing own cash resources, feeding and with minimal assistance on dressing/grooming and bathing. Based on the information gathered during the course of the investigation, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 6, 2025 · control 31-AS-20240917160355

Allegation investigated: Staff did not prevent resident from hitting another resident in care

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with the administrator, Marine Karapetian, and advised her of the complaint. It was reported that staff did not prevent Resident 2 (R2) from slapping Resident 1 (R1) in the face. Moreover, staff did not intervene or provide any assistance for R1. Today's investigation consisted of interviews with staff and residents. LPA also conducted a physical plant inspection to insure the health and safety of the residents, and obtained copies of resident records for review. Interviews with the administrator and staff reveal that the incident occurred at around 8:15am on 03/11/25. Both administrator and staff state that an argument arose between the residents over a dining room chair. Incident occurred early morning, as residents were getting ready for breakfast, therefore no other residents were present yet at the time of the altercaion. Administrator acknowledged both residents were being aggressive towards each other, but deny the lack of supervision by staff, as both residents were redirected Unsubstantiated immediately. Neither residents sustained an injury during the conflict. This was the first time that R1 and R2 had an altercation. No previous incidents between the two in the past. According to the administrator, R1 has a history of confusion, but is not aggressive. R1 does have a history of making false accusations and doesn't adjust as well socially. R2 is active amongst the community, but has no history of being aggressive towards peers. R2 also does not have a history of confusion or being aggressive. Interviews with ten (10) of ten residents could not confirm the allegation. In addition to interviews, LPA was able to review surveillance of the incident that occurred at 8:15am, on 03/11/25. LPA observed both R1 and R2 in the dining room together, when the altercation between the two occurred. LPA observed and confirmed that it was R1 that struck R2, but staff was present, and did intervene between the two residents, redirecting both residents. Although there was an altercation between R1 and R2, that lead to R1 striking R2, there wasn't enough evidence to prove that staff did not prevent resident from hitting another resident in care. as there was staff supervision present to intervene and redirect both residents. Moreover, licensee did submit an Incident Report (IR) to the Licensing agency regarding the incident. Therefore, based on the information obtained the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Mar 18, 2025 · control 31-AS-20250311124016

Allegation investigated: Resident has been financially abused while in care Staff are isolating a resident Staff do not meet a resident's hygiene needs

This report is an amendment of report dated 02/20/25 to rectify typographical errors. No change in findings. Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Administrator Marine Karapetian and explained the reason for the visit. LPA conducted a physical plant tour at 9:56 AM, requested copies of facility documents relevant to the investigation at 10:28 AM, reviewed records from 10:30 AM to 12:00 PM and interviewed staff and residents between 12:15 PM to 1:30 PM. Regarding the allegation that Resident has been financially abused while in care, it was alleged that Resident #1 (R1) reported that R1's money has been taken from R1. LPA's record review today between 10:30 AM to 12:00 PM, revealed that R1 is currently enrolled on Assisted Living Waiver Program (ALWP) and has a Share of Cost (SOC) of R1's Social Security Supplemental Income SSI) and as an SSI recipient, receives monthly Personal and Incidental (P & I) allowance of $179 per month, which R1 received and signed for every 1st of every month. Unsubstantiated (continued from LIC 9099) There was no evidence that the facility is taking any money from R1. Regarding the allegation that Staff are isolating a resident, it was alleged that R1 is being isolated by the staff. LPA's record review today between 10:30 AM to 12:00 PM, revealed that R1 was able to ambulate with walker, able to leave the facility unassisted and capable of self-care including but not limited to showering, toileting, dressing and grooming. Further review also revealed that R1 has been attending Adult Day Health Center (ADHC) program since 12/11/2023. LPA's interview with three (3) care staff today between 12:15 PM to 1:30 PM, also revealed that R1 always leaves the facility upon arrival from the day program almost daily to go to the store to buy food and/or personal stuff. Regarding the allegation that Staff do not meet a resident's hygiene needs, it was alleged that R1’s hygiene is also an issue at this facility. LPA's record review today revealed that R1 is capable of self-care including but not limited to showering, toileting, dressing and grooming. LPA's interview with three (3) care staff also revealed that all three (3) care staff remind R1 of hygiene and offered assistance to R1 but R1 refused. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Feb 20, 2025 · control 31-AS-20250218003240

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff is financially abusing resident

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with staff Anush Khudatyan and explained the reason for the visit. LPA conducted physical plant tour at 10:02 AM, requested copies of facility documents relevant to the investigation at 10:36 AM, reviewed facility documents between 10:45 AM to 11:45 AM and interviewed staff between 12:00 PM to 1:15 PM. Regarding the allegation that the Staff is financially abusing Resident #1 (R1), it was alleged that the facility is still receiving R1's Social Security money since R1 left in February 2024 up to November 2024. LPA's interview with the administrator on 11/12/24 at around 12:30 PM, revealed that R1 was receiving two (2) Social Security Check through direct deposit, one (1) for regular Social Security Pension (SSP) and another for Supplemental Income (SSI). Immediately after R1 was confirmed of not coming back to the facility as a family member (FM) took R1's belongings from the facility, the administrator requested the SSA to stop the direct deposit of R1's check to the facility. Unsubstantiated (continued from LIC 9099) The administrator confirmed that the Social Security Administration (SSA) did stop the direct deposit but only the SSA continued to direct deposit to the facility's account R1's SSI payment. LPA's record review today between 10:45 AM to 11:45 AM, revealed that the facility faxed request to SSA to stop payment to no avail, the facility then received the invoice from SSA and returned to SSA all the payment made to the facility on behalf of R1, the last being on 11/06/24 with the receipt from SSA. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 28, 2025 · control 31-AS-20241108102704

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Resident is not getting appropriate incidental medical care- Resident’s dietary needs are not being met- Staff failed to ensure proper medication assistance- Staff is neglecting Resident care and supervision-

On Thursday, 1/16/25, at 10:00 am, Licensing Program Analyst, (LPA) Raymond Comer, arrived to conduct a subsequent visit regarding the allegation(s) listed above. LPA conducted the initial complaint visit on 1/06/25. LPA met with facility Administrator, Marine Karapetian, presented official CDSS badge identification, and reason for the visit was disclosed. At 10:10 am, A physical plant tour of the facility was conducted by LPA; No health and safety issues were observed. To investigate the allegation(s), LPA received Facility resident roster, and Staff roster. At 10:15 am, LPA reviewed Resident 1's (R1) file, and other documents relevant to the investigation. Between 10:45 am and 12:30 pm, LPA conducted on-site interviews with Staff, and Residents. [LIC 809-C Continued] Unsubstantiated Allegation: Staff failed to ensure proper medication assistance - The Reporting Party (RP) alleges that Resident#1 (R1) is not encouraged by staff to take their medications daily. To investigate the allegation, LPA conducted a records review of R1's file, which revealed the following: Medical Administration Records (MAR) indicate staff tracking of prescribed medications taken/refused by R1. LPA interviews with staff revealed the following: Both Administrator and staff deny the allegation, stating that R1 is encouraged by staff to take their medicine, despite occasional refusals. LPA interview with R1 revealed the following: R1 states that "[staff] try to get me to take my meds...even when I don't want to". LPA interviewed a total of seven (7) residents. Six (6) out of seven (7) residents do not corroborate the allegation, stating that staff do provide proper medication assistance. Although this allegation may have occurred, or is valid, there is not a preponderance of evidence to prove the alleged did, or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time. Allegation: Staff is neglecting Resident care and supervision - The Reporting Party (RP) alleges that Resident#1 (R1) is not assisted by staff to accomplish their Activities of Daily Living. (ADL's) To investigate the allegation, LPA conducted a records review of R1's file, which revealed the following: Review of R1's care plan shows R1 requires assistance with bathing, dressing, grooming, and encouragement to take medications on a daily basis. LPA interviews with Administrator and staff revealed the following: Staff deny the allegation, stating that staff assist R1 with their ADL's on a daily basis. LPA interviewed R1, who states that staff do provide them assistance with their daily needs. LPA interviewed a total of seven (7) residents. Six (6) out of seven (7) residents do not corroborate the allegation, stating that staff are providing resident assistance to meet daily needs. Although this allegation may have occurred, or is valid, there is not a preponderance of evidence to prove the alleged did, or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time. Allegation: Resident is not getting appropriate incidental medical care- The Reporting Party (RP) alleges that Resident#1 (R1) was not provided staff assistance in scheduling and transporting R1 to medical appointments. To investigate the allegation, LPA conducted a records review of R1's file, and other relevant documents, which revealed the following: Records show appointments scheduled for neurologist, ophthalmologist, cardiologist specialists, etc. For this investigation, LPA interviewed a total of four (4) staff, which revealed the following: Both Administrator and staff deny the allegation, stating incidental medical needs, including making appointments are met. LPA interviewed R1, who states that staff do schedule their doctor appointments, and prep R1 to ensure they are ready to be transported to the doctor's office. During the investigation, LPA interviewed a total of seven (7) residents. Six (6) out of seven (7) residents do not corroborate the allegation, stating that staff do provide assistance with their incidental medical needs. Although this allegation may have occurred, or is valid, there is not a preponderance of evidence to prove the alleged did, or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time. Allegation: Resident’s dietary needs are not being met- The Reporting Party (RP) alleges that Staff do not provide Resident#1 (R1) the proper diet as stated in the care plan, and that food for R1 is not available during un-scheduled meal periods. To investigate the allegation, LPA conducted a records review of R1's file, and other relevant documents, which revealed the following: Records show R1 is required to be on a "renal diet". LPA conducted a observation of the facility kitchen and found a post listing R1, and all other residents requiring renal and diabetic restrictions. LPA Interviews with Administrator and kitchen staff revealed the following: Staff deny the allegation, stating R1 is provided a low salt/low sugar diet, with moderate protein portions. LPA interviewed R1, who states that staff do provide food to them during routine meal times, and "after-hour" meals/snacks when requested. During the investigation, LPA interviewed a total of seven (7) residents. Six (6) out of seven (7) residents do not corroborate the allegation, stating that staff do provide "after-hour" meals and snacks when requested. Based on the information gathered from this investigation, Although this allegation may have occurred, or is valid, there is not a preponderance of evidence to prove the alleged did, or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time. [LIC 809-C Continued]the state’s words, verbatim · CDSS document, Jan 16, 2025 · control 31-AS-20241227120620

Allegation investigated: Resident sexually assaulted by male staff

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced visit and met with Administrator Marine Karapetyan to explain the purpose of the visit, which was to finalize the complaint allegation received. On January 9, 2023, the Woodland Hills Regional South Adult and Senior Care Office received a complaint alleging, “Resident was sexually assaulted by male staff.” The complaint was referred to the Community Care Licensing Division’s (CCLD) Investigations Branch (IB) and assigned to Investigator Heidy Bendana for further review and interview of the alleged victim/resident. Investigator Bendana interviewed resident #1 (R1), who denied being touched inappropriately. (R1) stated that staff #1 (S1) was unfamiliar with cleaning (R1) after toileting. Based on (R1’s) statements, IB determined that the allegation did not require escalation to a full investigation. On January 15, 2023; July 15, 2024; and October 17, 2024, between 8:30 a.m. and 4:30 p.m., LPA T. Cabiness conducted additional visits to follow up on the matter, interviewing (R1), (S1), and other residents and staff. Unsubstantiated During these visits, (R1) declined to discuss the allegation further, stating, “I forgot about it, and I’m not going to talk about anything.” (R1) also commented, “I have no issues, and the staff are very nice.” In a separate interview, (S1) reported that (R1) expressed dissatisfaction with the way (S1) was providing assistance during toileting and requested that another staff member assist. Administrator Karapetyan confirmed that (R1’s) request was granted, and (S1) was reassigned to assist other residents. Based on the findings from Investigator Bendana’s initial interview and LPA’s subsequent interviews, the allegation is deemed Unsubstantiated at this time. Exit interview and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Nov 15, 2024 · control 31-AS-20230109085206

Allegation investigated: Staff do not ensure medications are dispensed as prescribed to resident

This report is being amended to rectify typographical and grammatical error. No change in findings. Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Administrator Marine Karapetian and explained the reason for the visit. LPA conducted physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and resident between 11:00 AM to 1:00 PM. Regarding the allegation that Staff do not ensure medications are dispensed as prescribed to resident, it was alleged that Resident #1 (R1) appeared to be over medicated when admitted to the hospital on 08/19/24. LPA's record review on 08/23/24 between 10:30 AM to 12:00 PM revealed that R1 has a medical condition that needs constant monitoring but does not necessarily need medication to be administered constantly. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Further review also revealed that R1 needs only minimal assistance on medication management. LPA's interview with R1 revealed that R1 was being administered medication for R1’s medical condition every morning by a nurse but not on the day when R1 was hospitalized on the morning of 08/19/24. LPA's interview with two (2) staff on 08/23/24 confirmed that the care staff was about to clean and change R1 to get ready and bring R1 to the dining area for breakfast but noticed that R1 was not responsive as usual so they called 911 and brought R1 to the hospital. LPA's interview with Resident #2 (R2) who is the room mate of R1, today at 1:35 PM, also confirmed that R1 was administered medication by the nurse every morning but not on the day that R1 was last hospitalized in August. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 11, 2024 · control 31-AS-20240819144755

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Gary Tan and Michael Cava met with Administrator Marine Karapetian for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 9:34 AM and the following was noted: There is only one entrance being utilized at the facility, the front main entrance door. There are required poster posted at the main door. Screening area is located immediately upon entrance. There is also a sign in sheet, hand sanitizer, gloves and masks available. The facility had submitted and approved Mitigation and Infection plan. There are hand sanitizing stations all over the facility. There are signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in common bathrooms and all over the common areas of the facility. The facility have designated visitors' area at the front yard. The facility has sufficient stock of PPE in the storage room. The facility is a single storey building with shared and private bedrooms and bathrooms. Exit signal alarms were tested and at 10:25 AM and observed to be operational. All indoor and outdoor passageways/exits were free of obstruction. There is no body of water in the facility. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and interconnected and back up and tests are done in house on a regular basis. The facility is equipped with sprinkler system which was last tested on 02/09/24 and valid until 01/31/27. Fire extinguishers are located all throughout the facility and were last serviced on 02/09/24. Fire Drill was last conducted on 07/30/24. (continued to LIC 809-C) (continued from LIC 9099) Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food and properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Bedrooms: The resident bedrooms were properly furnished with one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. There are four (4) common shower rooms in the facility, all observed to be clean and in good repair. Hot water was measured in random bathroom at the range of 109.7°F to 116.6°F and observed to be within the required limit. Common Areas: These includes the living room, dining room and outdoor areas. Facility common areas appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Medications were observed to be stored in designated Medication room. The Medication room was observed to be locked at the time of visit. There are two (2) sets of first aid kit in the Medication room. Resident/Staff File Review: LPA reviewed records of five (5) random residents and six (6) staff. Resident and staff records appeared to be complete and updated. Laundry room located in the hallway no, 2 observed to be locked during visit. There is no immediate health and safety hazard during this visit. Exit interview conducted. Copy of this report issued,the state’s words, verbatim · CDSS document, Aug 13, 2024

Allegation investigated: . Resident was not given medication as needed 2. Resident was not provided eyeglasses as needed 3. Resident was not provided a wheelchair as needed 4. Resident was not provided oxygen as needed 5. Resident(s) not accorded dignity

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with administrator Marine Karapetyan and explained the reason for the visit. The following was determined: Allegation # 1: It was alleged that resident was not given medication as needed. On 08/22/2022, former LPA Wendell Smith conducted the initial complaint visit and obtained documents pertaining to the investigation. During today’s visit, from 915am to 230pm, LPA conducted a physical plant inspection, additional interviews and obtained and reviewed documents. It was reported staff did not administer medication to resident # 1(R1). LPA attempted to interview (R1), and witnesses involved in the complaint; but was not successful. LPA reviewed documents, and it revealed that (R1) was administered medication according to the date that is in question. Residents interviewed today, reported to LPA, staff administer medication as directed. Therefore, based on documentation review, and interviews, the allegation is Unsubstantiated. Unsubstantiated Allegation # 2: It was alleged that resident was not provided eyeglasses as needed. On 08/22/2022, former LPA Wendell Smith conducted the initial complaint visit and obtained documents pertaining to the investigation. During today’s visit, from 915am to 230pm, LPA conducted a physical plant inspection, additional interviews, and attempted to interview (R1) and witnesses involved in the complaint; but was not successful. Interviews revealed (R1) was hospitalized for a short period of time, and during that time, the facility started to repair the plumbing issues in (R1’s) room. (R1) was discharged before the repairs were completed. (R1) had to be relocated to a temporary room and (R1’s) important personal belongings were transferred to the temporary room by staff, and the Administrator. (R1) was also allowed to enter (R1’s) room at any time, during the repair to gather any personal belongings (R1) wanted. (R1) also did not inform staff about the eyeglasses. Therefore, based on interviews, the allegation is Unsubstantiated at this time. Allegation # 3: It was alleged resident was not provided a wheelchair as needed. On 08/22/2022, former LPA Wendell Smith conducted the initial complaint visit and obtained documents pertaining to the investigation. During today’s visit, from 915am to 230pm, LPA conducted a physical plant inspection, additional interviews, and attempted to interview (R1) and witnesses involved in the complaint; but was not successful. Interviews revealed (R1) was hospitalized for a short period of time, and during that time, the facility started to repair the plumbing issues in (R1’s) room. (R1) was discharged before the repairs were completed. (R1) had to be relocated to a temporary room and (R1’s) important personal belongings were transferred to the temporary room by staff and the Administrator. LPA was informed, that (R1) mainly used (R1’s) walker and did not use the wheelchair. (R1) was also allowed to enter (R1’s) room during the repair to gather any personal belongings (R1) wanted. (R1) did not mention to staff, that (R1) needed the wheelchair. Therefore, based on interviews, the allegation is Unsubstantiated at this time. Allegation # 4: It was alleged resident was not provided oxygen as needed. On 08/22/2022, former LPA Wendell Smith conducted the initial complaint visit and obtained documents pertaining to the investigation. During today’s visit, from 915am to 230pm, LPA conducted a physical plant inspection, additional interviews, and attempted to interview (R1). LPA also attempted to interview witnesses involved in the complaint; but was not successful. Interviews revealed (R1) was hospitalized for a short period of time, and during that time, the facility started to repair the plumbing issues in (R1’s) room. (R1) was discharged before the repairs were completed. (R1) had to be relocated to a temporary room and (R1’s) important personal belongings were transferred to the new room by staff and the Administrator, including (R1’s) oxygen. (R1) also always carries a small and portable oxygen tank. Therefore, based on interviews, the allegation is Unsubstantiated at this time. Allegation # 5: It was alleged resident(s) not accorded dignity. On 08/22/2022, former LPA Wendell Smith conducted the initial complaint visit and obtained documents pertaining to the investigation. During today’s visit, from 915am to 230pm, LPA conducted a physical plant inspection, additional interviews, and attempted to interview (R1) and witnesses involved in the complaint; but was not successful. LPA interviewed residents today, and they reported, staff do treat them with respect and dignity. Therefore, based on interviews, the allegation is Unsubstantiated. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, May 28, 2024 · control 31-AS-20220815142833

Allegation investigated: Staff did not provide resident’s records to resident’s authorized representative in a timely manner

This report is amended to change the findings. Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this to investigate the above allegation. LPA met with administrator Marine Karapetyan and state the reason for the visit. LPA conducted physical plant tour at 9:30 AM, requested copies of facility documents relevant to the investigation at 9:49 AM and interviewed the administrator at 10:49 AM. It was alleged that the staff did not provide Resident #1 (R1)’s records to R1’s authorized representative who allegedly faxed the request to the facility on 03/12/24 but was not able to obtain the document until 04/12/24. LPA's interview with the administrator today at 10:49 AM revealed that the R1's authorized representative sent personnel to obtain copies of R1's records on 04/12/24, the administrator however denied that she received the faxed written request on 03/12/24 and only learned about it when R1's authorized representative called which she welcomed coming to the facility to obtain copies of R1's record. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted and copy of this report issued. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 16, 2024 · control 31-AS-20240410154132

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Apr 16, 2024

(19) To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. This requirement is not met as evidenced by: Based on record review and interview the licensee did not provide the records of R1 to the R1's authorized representative in a timely manner which poses a potential personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 16, 2024

Plan of correction: Cleared during visit. The facility had already provided the requested documents on 04/12/24

Allegation investigated: Staff did not safeguard resident's money

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit to this facility to investigate the above allegation. LPA met with administrator Marine Karapetian and explained the reason for the visit. LPA conducted physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and reviewed records from 10:30 AM to 12:00 PM. LPA also conducted interviews with administrator and resident between 12:05 PM to 1:18 PM. It was alleged that Resident #1 (R1) disclosed to the Reporting Party (RP) that R1 should be receiving $300 a month and that at the end of the month, R1 only has $180 left in own account when it should have been around $600 because R1 has not spent any money in the past couple of months. LPA's record review at 10:30 AM, revealed that R1 is a client of Los Angeles County Department of Health Services (LACDHS) under their program Flexible Housing Subsidy Pool Program (FHSPP) and the ones paying for R1's stay at the facility. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) The program also provides R1 with $168/month personal allowance similar to that of Supplemental Security Income (SSI)'s Personal and Incidental Needs allowance (PNA). Further review also revealed that the facility is not the payee of R1's SSI if R1 is at all enrolled to or eligible to receive SSI. Moreover, LPA's review of R1's PNA's record confirmed that R1 is taking cash money periodically and disbursed only by the administrator. LPA's interview with R1 at 1:00 PM confirmed R1's signature on the PNA log of the facility. LPA's further review of R1's PNA's log revealed that R1 withdraws cash money from R1's PNA account an average of 6-7 times for the last three (3) months and the remaining cash balance is accurate which is also confirmed by R1 during the interview. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 4, 2024 · control 31-AS-20240102165554