Day & Night Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Alberto Lopez, conducted an unannounced annual visit. LPA was met by staff Barry Patnett. Administrator Karen Mesropyan arrived a short time later. Infection Control: Facility has infection control plan, and no resident is currently infected with any infectious disease at the time of visit. Operational Requirements: Facility showed proof of liability insurance that expires 03/13/2027 Physical Plant: There is a total of five (5) bedrooms. There is a bedroom designated for staff next to the kitchen on your left-hand side. There is a total of four (4) bedrooms for residents’ use. All the bedrooms have proper bedding, night stands, and lamps in addition to overhead lighting. Rooms did not have chairs for all residents. There is adequate supply of linen stored in the cabinets next to the bedrooms. There are (3) bathrooms. The facility has a working phone number and land line. Fire Extinguisher is located near kitchen door on your left-hand side on the floor. It is fully charged and was last checked on 04/25/2025 Kitchen: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Food supply adequate stored in several cabinets and consists of the following cereal, canned goods, bottles of water. Dishwasher in kitchen properly installed and functioning. The refrigerator is in good condition and working. There were dead insects inside the refrigerator and promptly clean. There are smoke detectors/carbon monoxide throughout the house that were tested and work properly. They are hardwired and interconnected. There is also one in each room. The water temperature was tested for the bathrooms and are within regulation -112.5 -117.0 Fahrenheit. (Continued) (Continued from 809) Staffing: Facility staff are all over 21 years of age. Personnel Records/Staff Training: Three staff files were reviewed and two (2) of three (3) are missing CPR certificate and all three 2 of 3 staff are missing proof of ongoing training. Planned Activities: Facility has enough space for indoor and outdoor activities. Most residents were watching TV at time of visit. Food Service: There appears to be enough food for 2-day perishable and 7 day non-perishable Incidental Medical and Dental: Medication list for 3 residents was not available for review during visit. One resident had timed medication in bottle that should have been empty by 07/07/2026. One resident was missing D/C orders for all medications as administrator stated it was discontinued. Resident Rights/Information: Resident rights are in the resident files reviewed and facility has required signs posted. Resident Records/Incident Report: Facility was in compliance during the visit. Disaster Preparedness: LIC 602 needs to be updated to reflect staff responsible for assignment during emergencies. Facility did not have proof of current fire or emergency drill. Residents with Special Health Needs: Facility does not have any residents with special health needs per Administrator An exit interview was conducted, several citations were issued, technical violations issue, appeals rights and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Jul 11, 2026

The state marks this report as 14 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: POC

On 03/03/25, at 12:30pm, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, Plan Of Correction (POC) and was greeted by Kyzylgul Almamatova, Caregiver. The purpose of the POC visit is to make sure deficiencies were corrected on reports issued on 12/11/2024. The designated administrator, Karen Mesropyan arrived about twenty (20) minutes later. At 12:35 PM LPA toured the home and requested the following: LPA reviewed all three (3) resident files and all three (3) staff files. All three (3) resident files were completed and POC’s were cleared-Admission Agreement, Pre Placement Appraisal, Resident Appraisal, Physician's Report and tuberculosis clearance and Needs and Appraisal. Two (2) out of three (3) files were completed. Staff # 2 (S2) is still missing health screening. LPA received the training required by staff and the CPR-Cardiopulmonary resuscitation for clearance of POC. An additional staff has been hired and has a completed file at the facility. The medication, sharps, and chemicals were locked and inaccessible to residents-POC was cleared. The garage door and where they keep the sharps was repaired-POC cleared. Two (2) citations will be issued on 809-D for The Liability insurance Coverage that is required and S2 missing Health Screening. An exit interview was conducted, citation(s) were issued, appeals rights and a copy of this report was given to the designated administrator.the state’s words, verbatim · CDSS document, Mar 3, 2025

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Mar 12, 2025

HSC 1569.605 shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000). This requirement is not met by: Based on the record review, the licensee did not comply with the section cited above in one documentation not showing required liability insurance which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 3, 2025

Plan of correction: The licensee/administrator will send copy of liability insurance that is required to LPA by POC Due Date: 03/12/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(a)(11) · Plan of correction due date: Mar 12, 2025

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411...This requirement is not met as evidenced by: Based on the record review, the licensee did not comply with the section cited above in one out of three staff not having a health screening which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 3, 2025

Plan of correction: The health screening of S2 is to be sent to the LPA. POC Due Date 03/12/25

Type of visit: Required - 1 Year

On 12/11/24, at 09:25am, Licensing Program Analyst (LPA), Gina Saucedo, conducted an unannounced annual visit. LPA was met by resident Steven Gordon-Carroll. There was no staff present at the time of arrival. Resident Steven Gordon-Carroll called the staff and the staff-Karen Mesropyan arrived about thirty (30) minutes later. Facility is a single-story home. Today's site visit consisted of LPA touring the physical plant by themselves since there was no staff present at the time. Bedrooms: There is a total of five (5) bedrooms. There is a bedroom designated for staff next to the kitchen on your left-hand side. There is a total of four (4) bedrooms for resident use. All the bedrooms have proper bedding, chairs, night stands, lamps in addition to overhead lighting. There is adequate supply of linen stored in the cabinets next to the bedrooms. There was chemicals exposed to the residents. LPA took a picture of the chemicals being exposed by the washer and dryer and in the bathrooms. There are (3) bathrooms. The facility has a working phone number land line. Fire Extinguisher located near kitchen door on your left-hand side on the floor. It is fully charged but has an expiration date. Kitchen: Dishes, cups, and flat ware are stored in the kitchen cupboards, inspected and in good repair. Sharps are stored on your left side of the kitchen not locked and not secured accessible to residents. The cabinet was broken. Food supply adequate stored in several cabinets and consists of the following cereal, canned goods, bottles of water. Dishwasher in kitchen properly installed and functioning. The refrigerator is in good condition and working. LIC 809C-continued The dining/living room Resident & Staff Files: Has enough seating for staff and residents. The furniture is in good condition. There is no resident/staff files available for LPA to review. The staff stated they believed because the residents were independent they did not have to have files and reported the residents pay in cash. There are smoke detectors/carbon monoxide through-out the house that were tested and work properly. They are hardwired and interconnected. There is also one in each room. The water temperature was tested for the bathrooms are they are within regulation-114-119 Fahrenheit. Medication: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in the kitchen area along with the medication was not in an area secure, locked, and inaccessible to the residents. One (1) of the residents had their own medication in their room in a bag. LPA took a picture. Outside: LPA toured the outside area. LPA observed a covered shaded area for residents and appropriate outdoor furniture. The facility has no body of water on the premises. There is one (1) gate that is unlocked. There is a garage that is broken and needs repair. Administration: The Liability Insurance was reviewed and will be renewed on 01/21/2026. There are several Covid 19 signs on the wall, hygiene sanitation signs, YES, Emergency Disaster Plan and Facility Grievance Procedure. An exit interview was conducted, several citation(s) were issued and a civil penalty, appeals rights and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Dec 11, 2024

Type of visit: Prelicensing

On 02/14/24, at 09:25am, Licensing Program Analyst (LPA), Gina Saucedo, conducted an announced visit to the facility for purpose of a pre-licensing evaluation. An application was submitted to Community Care Licensing Division-CCLD on 05/11/2023, Initial license for a Residential Care Facility for the Elderly, 60 years and older. The requested capacity is for one (1) bedridden, four (4) non-ambulatory and one (1) ambulatory, total of up to six (6) residents. Facility is a single-story home. Today's site visit consisted of LPA touring the physical plant at 10:05 AM inside and outside and observed the following: Bedrooms Staff: There is a bedroom designated for staff next to the kitchen on your left-hand side. Bedrooms Residents: There is a total of four (4) bedrooms for resident use. BEDROOMS APPROVED FOR ONLY AMBULATORY SHALL NOT BE USED FOR NON-AMB, PER 85087. There shall be no more than two clients per bedroom. Bedrooms #1 (one) and bedroom #2 (two) is for non-ambulatory occupancy and will be shared occupancy, bedroom number #3 (three) is for bedridden occupancy only and has a private bathroom which is cleared by the Fire Safety Inspection Request. Bedroom number #4 (four) will be a single, ambulatory bedroom. All the bedrooms have proper bedding, chairs, night stands, lamps in addition to overhead lighting. LIC 809C-continued The dining/living room Resident & Staff Files: Has enough seating for staff and residents. The furniture is in good condition. The resident/staff files will be kept in an office area next to the living room/dining room area. Linens & Hygiene Supplies: Adequate supply of linen stored in the cabinets next to the bedrooms. Emergency Phone Numbers, Exit Plan & Menu: The facility has a working phone number land line. Fire Extinguisher located near kitchen door on your left-hand side mounted on the wall. It is fully charged and has a date of October 19, 2023. Food Service: Dishes, cups, and flat ware are stored in the kitchen cupboards, inspected and in good repair. Sharps are stored on your left side of the kitchen locked and secured. Food supply adequate stored in several cabinets and consists of the following cereal, canned goods, bottles of water. Dishwasher in kitchen properly installed and functioning. The refrigerator is in good condition and working. Smoke Detectors: There are smoke detectors/carbon monoxide through-out the house that were tested and work properly. They are hardwired and interconnected. There is also one in each room. Water Temperature: The water temperature was tested for the bathrooms are they are within regulation-114-119 Fahrenheit. Medications, First-Aid Kit & Book A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in the kitchen area along with the medication will also be kept in this area secure, locked, and inaccessible to the residents. LIC 809C-continued Pool/Jacuzzi: There is no pool/jacuzzi in the facility. Fire clearance: Fire Clearance was approved on 10/23/2023 signed and dated. Signal system: The facility does have a signal system installed. Administration: The facility had submitted a Mitigation and Infection plan. The insurance plan is current, Family Councils, Personal Rights of Residents, Rights of Resident by Council, Non-Discrimination Policy, and YES sign is at the entrance of the facility against the wall on your right side. Component III was shown to the Administrator, orientation process was completed. The administrator licensee is Meri Mkrtumyan and was received on 05-22-2023. Structure: Overall Facility is a five (5) bedroom home with three (3) bathrooms, single-story with a car, detached garage in the back of the facility. The home has a fireplace which is covered with a metal screen cover and is inaccessible to the residents. There is one (1) washer and dryer located next to the kitchen area where there will be toxins which are in a locked area and inaccessible to the residents. This is where the staff bathroom will be located. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Feb 14, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participants: Meri Mkrtumyan, Managing Member; Viktorya Hayrapetyan, Administrator Interview Method: Telephone interview On 1/16/24, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jan 16, 2024