California State Health Group Llc

Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda, Leizl DeLa Cerra, and Nadia Shahbazian conducted an subsequent complaint visit to the facility to investigate the above allegations. LPAs met with designee staff member, Isiah Phiri (S2) and was advised about the visit. Staff called administrator, Andranik Kapikyan, arrived at 9:35 AM; and was advised the reason of the visit. An entrance interview was conducted. Today's investigation involved interviews with the administrator and staff. LPAs also conducted a physical plant inspection of the facility at 9:24 AM to ensure the health and safety of the residents and a review of records. At 11 AM on 11.7.2024, LPA Ngo-Castaneda requested the resident and staff roster. During the investigation, interviews and record reviews were made. Continue to LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, January 27, 2025 · control 31-AS-20240904133101

Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Huma Rahimi conducted an subsequent complaint visit to the facility to investigate the above allegations. LPA met with designee staff member (Isiah Phiri) and was advised about the visit. Staff called administrator and Andranik Kapikyan arrived at 10AM; and advised the reason of the visit. An entrance interview was conducted. Today's investigation involved interviews with the administrator, staff, and residents. LPA also conducted a physical plant inspection of the facility at 9:40 AM to ensure the health and safety of the residents and a review of records. At 11AM, LPA requested the resident and staff roster. During the investigation, interviews and record reviews were made. Continue to LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, November 7, 2024 · control 31-AS-20240904133101

Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Gina Saucedo conducted an initial complaint visit to the facility to investigate the above allegations. LPA met with designee staff member (S1), Isiah Phiri and was advised about the visit. Administrator was not available; staff called administrator and advised the reason of the visit over the phone. An entrance interview was conducted. Today's investigation involved interviews with the staff and residents. LPA conducted a physical plant inspection of the facility at 10 AM to ensure the health and safety of the residents. At 10:10AM, LPA requested the resident and staff roster, reports could not be produce. Administrator and staff was not available to show records to LPA. A case management will be cited. During the investigation staff and residents interviews were made. Continue to LIC 9099-C SubstantiatedRead the full finding— CDSS inspection report, September 10, 2024 · control 31-AS-20240904133101

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted a initial complaint visit to the facility to investigate the above allegations. LPA met with designee staff member Isiah Phiri and was advised about the visit. Administrator was not available; staff called administrator and advised the reason of the visit over the phone. An entrance interview was conducted. Today's investigation involved interviews with the administrator, staff, and residents. LPA also conducted a physical plant inspection of the facility at 8:40 AM to ensure the health and safety of the residents and a review of records. At 9:33 AM, LPA requested the resident and staff roster. During the investigation, interviews and record reviews were made. Continue to LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, July 18, 2024 · control 31-AS-20240712144416

This is an amended report due to clerical error. On 02.17.2023 LPA Angela Panushkina was the one who initiated the investigation for the complaint not Melissa Ruiz. On 03.20.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced subsequent visit to deliver the determination on the above allegations. LPA was greeted by Isiah Phiri (S2) who granted access. S2 contacted the administrator Andranik Kapikyan (S1) to advise that LPA was at the facility. The administrator arrived at 2 PM, and LPA explained the purpose of the visit. At 12:25 PM LPA conducted a physical plant tour to ensure the health and safety of the residents in care. Allegation: Staff handled resident roughly Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted a subsequent complaint visit. Regarding the allegation above it is alleged that facility staff handled resident R1 roughly. On 02.17.2023 LPA Melissa Ruiz initiated this investigation for the complaint. CoRead the full finding— CDSS inspection report, March 20, 2024 · control 31-AS-20230213141642

Licensing Program Analysts (LPA) Leslie Ngo-Castaneda conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Andranik Kapikyan and advised administrator of the allegations. During the course of the investigation, LPA conducted interviews clients in the facility at 1:010 PM. With the assistance of the staff at 1:05 PM LPA took a facility tour. Allegation #1: Staff would not allow resident to come back to the facility In regards to the allegation, it was reported that the resident did not allow resident to come back to the facility due to their monthly dues. Interviews with residents in the facility revealed that no incident occurred during their stay in the facility. They are all content with the facility and have no issues with coming and going out of the facility. Staff interviews reveal that they always try to meet the client’s needs. Review of facility records also confirms that staff training and facility program was reviewRead the full finding— CDSS inspection report, February 21, 2024 · control 31-AS-20230131130307

There are two allegations: On 1.10.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced visit to address this complaint. LPA met initially met with staff Isiah Phiri who contacted the administrator. Administrator Andranik Kapikyan arrived at 10:20AM. LPA explained the reason for the visit. Entrance interview conducted. LPA conducted physical plant tour at 9:35am. At 9:40am LPA interviewed six (6) residents and reviewed resident records for any possible eviction notices. Continue to LIC 9099-C Unsubstantiated— CDSS inspection report, January 10, 2024 · control 31-AS-20240104081845

This an AMNDED report as further rewview of defciencies and fine that was issued incorrectly. This is to state that NO FINE has been cited and issued to facility. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit to deliver the finding for the above stated allegation. LPA met with the administrator and explained the reason for the visit. Entrance interview. Allegation: Staff do not ensure a safe and healthful environment is provided for resident. On 01-03-2024 LPM Gillyard and LPA Ngo-Castaneda initiated the visit. On this day, the home was observed to have a malodorous scent of urine. A black moldy patch was observed in room (3) on the base of the wall in size of 2x2. The wall paint was puckers due to water damage. The Administrator made observations and acknowledged indicating that there needs to be plumbing work done in the hallway bathroom. Continue to LIC 9099-C SubstantiatedRead the full finding— CDSS inspection report, January 10, 2024 · control 31-AS-20231227160159

This is an amendment of the original report issued 01-10-2024 to clarify the complaint findings. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit to deliver the finding for the above stated allegation. LPA met with the administrator and explained the reason for the visit. Today 1.10.2024 LPA conducted a tour of the home at 9:35AM. A black moldy patch was observed in bedroom three (3) on the base of the wall 2x2 inches in size. The Administrator (S1) was aware and acknowledged the presence of mold on the base of the wall in bedroom #3 and stated that there was a plumbing issue in bedroom #3 bathroom which caused the mold. The Administrator advice LPA that this is scheduled to be fixed and removed on 1.15.2024. An interview with staff member (S2) also confirmed and acknowledged mold formation in bedroom #3. Therefore, based on interviews, observation, and document review, there is sufficient information to support the allegation. ThRead the full finding— CDSS inspection report, January 10, 2024 · control 31-AS-20240104131120

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegation. LPA met initially met with staff Liana Gafikyan who called the administrator. Administrator Andranik Kapikyan arrived in about twenty (20) minutes. LPA explained the reason for the visit. LPA conducted physical plant tour at 9:40 AM, requested copies of facility documents relevant to the investigation at 10:00 AM and interviewed staff and residents between 10:10 AM to 12:00 PM. Regarding the allegation that Lack of care and supervision led to resident injury, it was alleged that Resident #1 (R1) sustained bruising to the face after a fall. LPA's record review revealed that R1 had the capacity for self care including but not limited to bathing, dressing and toileting. LPA's interview with staff who is still employed when R1 was here today at 11:30 PM, revealed that R1 was able to ambulate on R1's own and never had any fall when the staff was onRead the full finding— CDSS inspection report, June 21, 2023 · control 31-AS-20220128164153

Licensing Program Analysts Gary Tan and Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPAs met with the administrator, Adranik Kapiyan, and staff, Liana Gafikyan, and advised them of the complaint. Today's investigation consisted of interviews with the administrator, staff and residents. A physical plant inspection to insure the health and safety of the residents in care was conducted and record reviews were made. Also, during the course of the investigation, LPAs made a collateral visit to another facility, to conduct interviews with additional residents. Staff prevented resident from making/receiving phone calls: In regards to the allegation, it was reported that residents were not allowed to make phone calls or get in touch with family. LPAs were able to interview four (4) out of the six (6) residents, who deny the allegation. One resident was non verbal, and did not respond to LPAs questions. Another resident declined to interview. URead the full finding— CDSS inspection report, May 5, 2023 · control 31-AS-20230427151459

. It was alleged that a resident physically attacked another resident, causing Resident 1 (R1) injuries, resulting in hospitalization. The Unlicensed allegation was Substantiated on April 25, 2023 and a Notice of Violation of Law (NOVL) issued. At the time of the visit, the census was 6 of which 4 were transferred from California State Health Group LLC to the unlicensed by the Administrator. SUPERVISORS NAME : Nichelle Gillyard LICENSING EVALUATOR NAME : Melissa Ruiz LICENSING EVALUATOR SIGNATURE : DATE: 05/02/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2023 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04) Page: 1 of 2 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT (Cont) CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office ,Read the full finding— CDSS inspection report, May 2, 2023

On 4/14/2023, Licensing Program Analysts (LPAs) Melissa Ruiz and Angela Panushkina, arrived at the facility to conduct an initial complaint investigation. Upon arrival, LPAs were greeted by S1, and LPAs later met with the Administrator Andranik “Nick”. An entrance interview was conducted, and the purpose of the visit was explained. Allegation: Staff refused to provide resident with wound care. To investigate this allegation, LPAs conducted record review for R1 at 10:40 a.m. and LPAs did not observe a hospice care plan outlining the care R1 was receiving. LPAs also did not observe any hospice notes for R1’s hospice nurse visits. In addition, LPA requested the Administrator obtain hospice notes and records, and Administrator only provided a medication list from the hospice agency, no other documents were provided at the time of this report. Based on record review, the allegation is deemed Substantiated. SubstantiatedRead the full finding— CDSS inspection report, April 14, 2023 · control 31-AS-20230407084204