No Place Like Home for Golden Ages 3

Type of visit: Required - 1 Year

On 08/12/26, 08:55AM, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA met with Emma Topadzuikyan, Administrator and advised of the Required One (01) Year, Annual visit. A tour of the physical plant was conducted at around 9:45 AM and the following was noted: 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. There is a garage that has an entrance from the living room area. The facility has a total of four (04) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory and a hospice waiver for two (02). The facility is currently occupying four (04) residents. 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. Knives and sharps are observed to be locked and inaccessible to residents. The fire extinguisher is located in the kitchen fully charged and dated 08/2026. Laundry Room: There is one (1) washer and one (1) dryer. Detergents are kept in the laundry room locked and inaccessible to the residents. LIC 809-C-continued No firearms observed or will be maintained on the premises. The smoke alarm and carbon monoxide detector were tested and operational. They are hardwired. Living Room and Dining Room: The living and dining room are neat and clean. The facility maintains a comfortable temperature at 69°F. The medication is locked and inaccessible to the residents in a cabinet in the hallway. Bedrooms: Facility has four (4) bedrooms and were toured. The bedrooms are fully furnished with proper lighting and bedding. The bedrooms are two (2) currently shared and the other two (2) are single, occupied. Bathrooms: There are two (2) full bathrooms. The bathrooms contained a trash can with tight-fitting lid. There is one (1) bathroom that is in a resident's room. The hot waters were tested and measured around 115 within regulations. Administrative: The administrative Certification is current and expires 11/10/2027. The liability insurance expires on 05/01/27. There were Personal Rights, YES Sign, Ombudsman sign and Emergency Disaster Plan against the wall of the facility. The facility has cameras in common areas. Staff/Client Files: There were two (2) staff files reviewed at the above facility. There were four (4) resident files that were reviewed. Fire drills have been completed. An exit interview was conducted, no citation(s) were issued and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Aug 12, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Estelita San Pedro for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 01:45 PM and the following was noted: 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. The facility has a total of four (04) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory and a hospice waiver for two (02). The facility is currently occupying five (05) residents. 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 inaccessible to pests, however, preparation areas are not clean - kitchen cabinets and appliances are not clean and cabinets are not in good repair. Knives and sharps are not observed to be locked and inaccessible to residents. LPA requested for staff to move all sharps and knives to a locked location inaccessible to the residents. (continued on LIC 809-C) 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 near the kitchen and observed to be fully charged. 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. One (01) out of two (02) toilets in the facility was leaking and not in good repair. The hot water temperature was measured at 118.7°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. Facility does not maintain complete files for all staff on site. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): No other health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 13, 2025

Allegation investigated: Facility is unsanitary Facility is in disrepair

At approximately 10:30 a.m. on 01/03/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. To investigate the allegations above, LPA and toured the facility inside and out at 10:35 a.m. today and interviewed staff and residents between 10:45 a.m. and 12:00 p.m. Regarding the allegation "Facility is unsanitary" it was alleged a dirty diaper was left on a bathroom sink. A photograph of a diaper on a sink was provided to the Department, but it was indeterminable whether the diaper was dirty or not. During today’s facility tour, LPA observed clean, unused diapers and incontinence items on a bathroom sink. No dirty diapers or other refuse were observed in the home. Interview with Staff #1 (S1) at 11:20 a.m. today revealed staff immediately take diapers to an outside trash can after assisting residents with incontinence care. Three (03) out of three (03) residents interviewed had no issues with facility cleanliness or incontinence care. Unsubstantiated Interview with Resident #1 (R1) at 11:45 a.m. revealed staff “mop as frequent as possible”. Based on observations and interviews, the facility is sanitary. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation "Facility is in disrepair" it was alleged paint on the walls was chipping and some windows had broken coverings. LPA observed walls were in good repair. At approximately 10:45 a.m., LPA observed one (01) minor paint chip on the living room ceiling which did not pose an immediate or potential risk to the health, safety, or personal rights of residents in care. Interviews with three (03) out of three (03) residents interviewed revealed they had no issue with the state of the facility. LPA did not observe any broken window coverings. Based on observations and interviews, the facility is in good repair. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health or safety risks were observed during today’s visit. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 3, 2025 · control 31-AS-20241226160146

Allegation investigated: Resident was encourge to appoint licensee as their POA.

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit to deliver the findings for the above noted allegation. LPA met with caregiver Estelita San Pedro and explained the reason for the visit. It was reported that a resident was encouraged to appoint the Licensee as their power of attorney (POA). It was alleged that the Licensee was pressuring Resident #1 (R1) to make them their POA in exchange for two months of free rent at the facility. To investigate this allegation, on 03/12/2024, LPA attempted to interview R1. LPA was not able to speak to R1 since they were out of the community. Between 4:00pm and 5:00pm, staff interviews were initiated. Staff denied that they were encouraging R1 to make them their POA. On 8/29/2024, LPA Valenzuela conducted a subsequent visit to the facility to continue the investigation. LPA requested to speak to R1, but was told by staff that they no longer live there. R1 left the community sometime in the month of March. LPA was not able to contact R1, since the phone number provided was no longer in service. Unsubstantiated Based on interviews, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time. No health and safety issues noted at the time of this visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 29, 2024 · control 31-AS-20240308160649

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced required 1 year annual inspection visit. LPA met with Staff Estelita San Pedro. The purpose of the visit was discussed. There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms and two (02) bathrooms. The facility is fire cleared for six (06) non-ambulatory with a hospice waiver for two (02). The facility is currently occupying five (05) non-ambulatory residents of which one (01) are under hospice care. 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. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) 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. Living and dining room furniture were also checked. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 77°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 full and purchased September of 2023. 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 120 °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.the state’s words, verbatim · CDSS document, Aug 28, 2024

Allegation investigated: Licensee did not provide resident with copy of admissison agreement.

Licensing Program Analyst (LPA) Rosaura Valenzuela and Licensing Program Manager (LPM) Naira Margaryan conducted an unannounced visit for the above noted allegation. LPA and LPM met with Licensee Emma Topadzuikyan and explained the reason for the visit. It was reported that Licensee did not provide a resident with a copy of the admission agreement. To investigate this investigation on 3/12/24, between 3:50pm and 4:00pm facility records for Resident #1 (R1) were requested. Facility records for R1 were not provided to Licensing Agents because they were not created. Between 4:00pm and 4:15pm, staff interviews were initiated. Staff #1 (S1) was interviewed and revealed that R1 never signed an admission agreement because they did not want to sign it. Based on interviews, there is sufficient information to verify this allegtion. Thus, this allegation is SUBSTANTIATED at this time. No health and safety issues were noted at the time of this visit. Exit interview conducted and a copy of the report was issued. Substantiatedthe state’s words, verbatim · CDSS document, Mar 12, 2024 · control 31-AS-20240308160649

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(a) · Plan of correction due date: Mar 26, 2024

87507(a) Admission Agreements (a) The licensee shall complete an individual written admission agreement with each resident and that resident's responsible person or conservator, is any. This requirement was not met as evidenced by: Based on interviews the Licensee admitted that R1 did not have or sign an admission agreement. This poses a potential health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Mar 12, 2024

Plan of correction: The Licensee will submit in writing to the Department by 3/26/24, how they will ensure that all residents in care have a signed admission agreement.

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.

Type of visit: Case Management - Deficiencies

This case management visit was conducted in conjunction with complaint control number 31-AS-20240308160649 to address the deficiencies unrelated to the complaint allegations. On 3/12/24 at 3:00pm, during complaint investigation LPA Valenzuela and LPM Margaryan were informed that the Licensee/Administrator does not have facility file for Resident #1 (R1). No documents were available for Licensing agents to review. Therefore, under Title 22 Regulations, the following deficiency was cited and recorded on LIC 809D. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 12, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Mar 26, 2024

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Based on interviews, Licensee did not have any records for R1.the state’s words, verbatim · CDSS document, Mar 12, 2024

Plan of correction: The licensee will submit in writing to Licensing by 3/26/24, how they will ensure that all resident records are complete and readily available upon request to Licensing Agents.