Serene Nature Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual inspection to the facility above and met with Goar Karapetian who granted access to LPA. The staff contacted the Administrator Rima Abelian and LPA explained the reason for the visit. A tour of the physical plant was conducted at 10:00 AM and the following was noted: The facility is a single-story building. It has a total of six (06) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying five (05) non-ambulatory residents. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. At 10:00 AM, LPA observed adequate supplies of perishable food for at least two (2) days and nonperishable food for seven (07) days. All knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. LPA observed cleaning supplies to be locked under the kitchen sink. Fire Extinguisher was last purchased on 01/22/2025. Medication: LPA observed centrally stored medication to be locked and in accessible to residents in care in a cabinet in the dining room as well as staff and residents files. Continue on LIC809-C BEDROOMS: There are five (4) bedrooms designated for resident’s use. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Facility has a bedroom designated for staff use only and LPA observed locked and inaccessible to residents in care. BATHROOMS: At 10 15 AM, LPA observed one bathroom designated for residents and one bathroom designated for staff use only. Resident’s bathroom appeared to be clean and in good repair. Properly supplied with toilet papers, soap; and paper towels. LPA observed appropriate grab bar and had non-skid mat. Hot water temperature measured at one of the bathrooms at 119.0°F. COMMON AREAS: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. LAUNDRY ROOM: The laundry room is located by the kitchen. All cleaning supplies and laundry detergents were locked and inaccessible to residents in care. The washer/dryer appear to be in good condition. SURROUNDING GROUNDS: The back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There is one emergency exit and it was observed unlocked. There are no bodies of water. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:35 AM, they were tested and observed to be operational. Between 11:00 PM to 12:30 PM, LPA reviewed records of three (3) residents and one (1) staff. Residents and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency cited. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with RIma Abelian for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at 10:00 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of six (06) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory. The facility is currently occupying six (06) non-ambulatory residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 78°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located in the kitchen, observed to be fully charged and last inspected on 11/03/2023. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 109.8°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication and first aid kit to be locked and inaccessible to residents. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 27, 2024

Allegation investigated: Staff did not ensure the safety of food products provided to residents. Staff did not assist resident with hygiene care. Staff do not provide planned activities for residents.

At 10:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with S1, who granted access to the facility. The Administrator arrived shortly after and LPA explained the reason for the visit. During course of the investigation, interviews and record review were made. At 10:05am, LPA requested resident and staff roster. At 10:10am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Personal & Incidental (P&I) Log, relevant to the investigation. At approximately 10:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:20am – 12:30pm, LPA interviewed the Administrator, two (2) staff, and five (5) out of six (6) residents. Continue on LIC9099-C Substantiated Allegation: Staff did not ensure the safety of food products provided to residents. On 06/20/2024 a credible witness conducted a routine inspection at the facility and observed expired, up to two years, perishable and nonperishable food items in the pantry, refrigerator, and freezer. During today’s visit, LPA conducted an interview with the Administrator who confirmed that the expired food had been already thrown away and new groceries have been purchased and re-stocked. Based on today’s interview and the information gathered this allegation is Substantiated. Allegation: Staff did not assist resident with hygiene care. It was alleged that on 06/20/2024 a credible witness conducted a routine inspection at the facility and observed R1 had overgrown toe nails and indications of a fungal infection on a big toe. To investigate this allegation, LPA conducted an interview with the Administrator who confirmed that R1 hasn't been seen by a Podiatrist for some time. Administrator also informed LPA that R1's doctor had been notified and a Podiatry referral had been approved. However, R1's request for an appointment is still pending. Based on today’s interview and the information gathered this allegation is Substantiated. Allegation: Staff do not provide planned activities for residents. It was alleged that the facility does not provide planned activities for the residents. To investigate this allegation, LPA conducted an interview with the Administrator and was informed the facility does not have planned activities for the residents. There are some board games or television for residents to partake in, but nothing planned. Moreover, five (5) residents interviewed confirmed that they only come out from their rooms during the meal hours and once they are done, they go back to their room with no further activities. Based on today’s interview and the information gathered this allegation is Substantiated. Deficiencies issued per Title 22. Exit interview conducted appeal rights explained and copy of this report signed and delivered. Allegation: Staff restrict residents to their rooms. It was alleged that residents are not allowed to come out to common areas, such as living room and back yard, and are kept in their room whole day. To investigate this allegation, LPA conducted an interview with the Administrator and two (2) staff, and all parties interviewed denied the allegation. In addition, LPA conducted interviews with six (6) residents and five (5) out of six (6) residents who were able to communicate also denied the above allegation and informed LPA that no such restrictions were made by the facility and all residents are allowed to come to the living room anytime. Based on today’s interview and the information gathered this allegation is deemed Unsubstantiated. Allegation: Staff are withholding residents’ personal funds. It was alleged that the residents' personal funds are not being provided to them and are being withheld by the staff. To investigate this allegation, LPA conducted an interview with the Administrator who denied the above allegation. LPA was informed that residents can access their funds by making a request. After the request, the funds get disbursed in the form of cash and a P&I log is being signed by the resident upon receipt. LPA was also provided with copy of the bond, signed and dated on October 28th, 2022 along with P&I log records. LPA reviewed the records and counted the funds. LPA observed P&I log, receipts and savings funds to be complete and accurate. Moreover, interviews with five (5) out of six (6) confirmed that they receive their P&I funds upon request and expressed no concerns regarding this allegation. Based on today’s interview, record review and the information gathered, the facility did not mismanage resident funds. Therefore, this allegation is deemed Unsubstantiated. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 27, 2024 · control 31-AS-20240621105259

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Jul 4, 2024

General Food Service Requirements: (b) The following food service requirements shall apply: (8) All food shall be of good quality... This requirement is not met as evidenced by: Based on the inspection conducted by a credible witness on 06/20/24, the licensee did not comply with the section cited above by having an expired food at the facility, which poses/posed a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 27, 2024

Plan of correction: Correction was cleared during todays visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Jul 4, 2024

Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (1) The licensee shall arrange, or assist in arranging, for medical and dental care... This requirement is not met as evidenced by: Based on the inspection conducted by a credible witness on 06/20/24, the licensee did not comply with the section cited by not making necessary arrangement for R1 to be seen by a Podiatrist, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 27, 2024

Plan of correction: Administrator will schedule an appointment for R1 to be seen by a Podiatrist and provide LPA with the appointment date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219 · Plan of correction due date: Jul 4, 2024

Planned Activities: (a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities... (3)Leisure time activities cultivating personal interests... This requirement is not met as evidenced by: Based on interviews, licensee did not comply with the section cited above by not providing planned activities for the residents, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 27, 2024

Plan of correction: Administrator will submit a copy of facility’s monthly activity schedule. Administrator will also submit a statement of understanding on how the facility, moving forward, will provide/engage residents in an activity.

Type of visit: Required - 1 Year

On 12/13/2023 at 9:00 AM Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – Annual Continuation Inspection and met with Rima Abelian, Administrator. Five (5) residents and two (2) staff were present during this inspection. Facility is licensed to serve six (6) non-ambulatory residents. The facility also has an approved hospice waiver for two (2) residents. The facility currently has 6 non-ambulatory residents. The Annual Licensing Fees are current. The home consists of 1 floor level with: 1 staff room, 3 resident rooms, 4 restrooms, kitchen, dining room, laundry room. At 09:15AM LPA conducted a physical plant tour. The administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, hot water temperature properly measured between 112.5-113.1 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two day supply of perishable and a seven day supply of non-perishable food. Knives and toxics were kept in a locked storage cabinet. First Aid kit was available. This facility has two (2) fire extinguisher, last serviced November 23,2022, LPA observed one extinguisher located in the kitchen and second extinguisher in the living room. LPA tested all carbon monoxide detectors and smoke detectors located in the kitchen area. Both devices were functional. LPA observed that all bedrooms and hallways are equipped with a carbon monoxide and smoke detector. At 10:10 AM LPA conducted a file review. 4 staff records were reviewed, 4 out of 4 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. 6 resident records were reviewed and, 6 out of 6 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. An exit interview was conducted. A copy of this report and appeal rights were discussed and left with Administrator Rima Abelian.the state’s words, verbatim · CDSS document, Dec 13, 2023