KK Sunnybrae Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Tuesday Cabiness conducted an announced annual visit to the above facility. LPA met with Administrator, Karine Karapetyan, and explained the reason for the visit. Today's site visit consisted of touring the physical plant inside and outside and observed the following: Current census is (5). Common areas: living, dining, and family room was neat, clean and appropriately furnished. Kitchen area had sufficient supplies of two (2)-days perishable and seven (7) days nonperishable food. There are (2) extra refrigerators located in the garage, stocked with food. All food was labeled and properly stored. All knives and sharps are locked in the kitchen drawer and inaccessible to residents. Medications are kept in the locked kitchen cabinet. There are (5) bedrooms, with (1) room for staff. All resident bedrooms are appropriately furnished with sufficient closet space and lighting. There are exit/sliding doors with auditory alarms that are operational. The facility has two and a half (2½) bathrooms in good repair and properly supplied with toilet papers, and soap.Appropriate grab bars and non-skid mats were also observed. Hot water temperature measured at 106°F. The facility maintains a comfortable temperature at 78°F. No obstructions and or tripping hazards throughout the facility. The fireplace located in the dining room is adequately closed and inaccessible to residents in care. The laundry is located in an attached garage and LPA observed washer/dryer in a good condition. All laundry supplies are kept locked and inaccessible to residents in care. (See LIC9099C) Smoke detectors and carbon monoxide were located throughout the facility; they were operational, with fire doors installed at the facility. The backyard has sufficient space and appropriate outdoor furniture, with a covered shaded area, with (3) exit gates. There are no bodies of water, and the backyard is fenced all around. First Aid Kit had all required supplies. Fire extinguisher was placed by the kitchen/dining areas and was observed fully charged. Record Review: Resident and staff records appeared to be complete and updated. Medication records: no discrepancies and medications are being administered according to doctor's orders. Exit interview and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Apr 18, 2026

Allegation investigated: Staff did not ensure resident received proper wound care Staff did not ensure resident was kept clean

At approximately 9:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent visit to deliver final findings. LPA met with the Staff #1, who granted access to the facility. LPA contacted the Administrator and explained the reason for the visit. LPA was informed that the Administrator will not be able to come and designated S1 to sign the report. Initial visit was conducted on 02/04/2025 and during course of the investigation, LPA requested resident and staff roster. At 09:45am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, relevant to the investigation. At approximately 10:00am, 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 conducted an interview with the Administrator, two (2) staff, a witness/visitor and two (2) out of three (3) residents. Continue on LIC9099-C Unsubstantiated Allegation: Staff did not ensure resident received proper wound care It was alleged that R1 had an open wound below his/her right knee and that ''barrier cream" was put onto the open wound by the facility staff. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that R1 had no pressure wounds. However, due to R1’s medications and dry skin, R1 developed abrasions (on legs) caused by scratching. LPA was informed that the staff redirects R1 and reminds R1 not to scratch his/her legs. LPA was also informed that no cream/ointment was ever prescribed nor applied to R1’s legs. The staff treats R1’s scratches / wound below the knee with soap and water. Interview with two staff members confirmed the statement provided by the Administrator and both staff interviewed denied the above allegation. During the initial visit, LPA observed R1’s legs covered with abrasions caused by itching. LPA also observed proper first aid, like covered scratches with clean dressing placed on R1’s right leg to prevent it from getting infected. Lastly, interview with R1 also confirmed that the staff always provides proper care by cleaning his/her legs with soap and water and no ointment/cream has been ever applied to R1’s leg. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated, at this time. Allegation: Staff did not ensure resident was kept clean It was alleged that R1 was covered in old feces upon arrival to the hospital. To investigate this allegation, LPA conducted an interview with the Administrator and two (2) staff members. All parties interviewed denied the above allegation and informed LPA that before R1 was taken to hospital S1 changed R1’s diaper/pull-ups. Interview with R1 also confirmed that prior to paramedic’s arrival on 01/29/25, S1 cleaned and changed R1’s diaper/pull-ups. Additionally, LPA conducted an interview with the facility witness/visitor and was informed that they visit the facility at least twice a week and observed all residents to be clean and well taken care of. Two (2) out of three (3) residents interviewed expressed no concern regarding this allegation. Lastly, during the initial visit, LPA observed the facility common areas and resident rooms were clean and free of odor. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated, at this time. No deficiency issued. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 31-AS-20250130090549

Allegation investigated: Staff is financially abusing a resident Staff is interfering with a resident's insurance Staff threatened a resident with eviction

This is an amended to the original report issued 10/15/2025. Additional information was added to clarify the investigation. At approximately 09:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit in response to the above-mentioned allegations. LPA met with the Staff #1, who granted access to the facility. LPA contacted the Administrator and explained the reason for the visit. LPA was informed that the Administrator will not be able to come and designated S1 to sign the report. At 09:15am, LPA requested resident and staff roster. At 09:20am, LPA requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, Staff Trainilng, relevant to the investigation. Between 09:30am – 11:30am, LPA conducted an interview with the Administrator, two (2) staff, R1's Power of Attorney (POA) and four (4) out of five (5) residents. Continue on LIC9099-C Unsubstantiated Allegation: Staff is financially abusing a resident It was alleged that the Administrator is attempting to redirect R1’s Social Security Income (SSI) into another account and will often call the Social Security Administration (SSA) regarding R1’s payments without R1’s knowledge. To investigate this allegation, LPA conducted an interview with the Administrator who denied the allegation and informed LPA that she can't solely make any changes as she does not have the authority to do so. Administrator also informed LPA that R1 wanted to schedule an appointment with SSA and asked the Administrator to schedule it for him/her. Around end of 09/29/2025 or 09/30/2025, the Administrator contacted the SSA's (1800…) number and scheduled an in-person appointment for 10/06/2025. R1 was taken to SSA by the Administrator on his/her scheduled day and no other phone calls to SSA were made by the Administrator on R1’s behalf. Interview with R1 also confirmed that R1 asked the Administrator to schedule an appointment and no other calls were made to SSA by the Administrator. LPA contacted R1's Power of Attorney (POA) and was informed that he/she is well aware of the call, made by the Administrator, to schedule an appointment for R1. Four (4) out of five (5) residents interviewed expressed no concern regarding this allegation. Therefore, based on interviews and information gathered during today’s visit this allegation is deemed Unsubstantiated, at this time. Allegation: Staff is interfering with a resident's insurance It was alleged that the Administrator changed R1’s insurance without involving R1. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that when R1 was picked up from the nursing home, the Administrator had a conversation with R1 and R1’s POA about Medi-Cal plan that may cover long-term services and supports (LTSS). All parties agreed to make changes, so that R1’s Medi-Cal plan can help coordinate access to state programs that cover supportive services, such as Assisted Living Waiver (ALW). LPA contacted R1’s responsible person and also conducted an interview with R1. Both parties interviewed corroborated the statement provided by the Administrator. Four (4) out of five (5) residents interviewed expressed no concerns regarding the above allegation and informed LPA that the facility Administrator and the staff are very respectful and professional toward their personal rights and before any changes are made, the Administrator always communicates with residents and or their responsible party. Therefore, based on interviews and information gathered during today's visit this allegation is deemed Unsubstantiated, at this time. Continue on LIC9099-C Allegation: Staff threatened a resident with eviction It was alleged that the Administrator threatens to evict R1 if R1 does not cooperate. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that facility has not issued or verbally mentioned any eviction to R1. Additionally, the Administrator stated there are currently no pending eviction notices that were issued, and she hasn't had to issue an eviction to anyone within the last 30-60 days. Interview with R1 and R1 POA expressed no concerns regarding this allegation. Lastly, R1’s records were reviewed, and LPA did not observe an eviction that has been issued to R1. Therefore, based on interviews and record review this allegation is deemed Unsubstantiated, at this time. No deficiency cited during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 31-AS-20251009121033

Type of visit: Required - 1 Year

At 09:30am Licensing Program Analyst (LPA), Angela Panushkina conducted an announced annual visit to the above facility. LPA met with Administrator, Karine Karapetyan, and explained the reason for the visit. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of team touring the physical plant inside and outside and observed the following: The facility currently has three (3) residents, one (1) of which is bedridden/hospice in room #4. At 10:20am, LPA toured the kitchen area and observed adequate supplies of two (2)-days perishable and one (1) week nonperishable food. All knives and sharps are locked in the kitchen drawer and inaccessible to residents. Additionally, LPA observed all medications are kept in the locked kitchen cabinet. LPA inspected the First Aid Kit and observed all required equipment’s are available. Fire extinguisher was placed by the kitchen/dining areas and was observed fully services. At 10:30am, LPA visited four (4) resident bedrooms and observed all rooms appropriately furnished with sufficient closet space and lighting. Two (2) out of four (4) rooms have exit/sliding doors and LPA observed auditory alarms operational. LPA was informed that the facility currently has two (2) dementia residents and awake staff. The facility has two and a half (2½) bathrooms in good repair and properly supplied with toilet papers, soap and paper towels. Appropriate grab bars and non-skid mats were also observed. At 10:45am, the hot water temperature measured at 110°F. The facility maintains a comfortable temperature at 78°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Continue on LIC809-C The fireplace located in the dining room is adequately closed and inaccessible to residents in care. The laundry is located in an attached garage and LPA observed washer/dryer in a good condition. All laundry supplies are kept locked and inaccessible to residents in care. Smoke detectors and carbon monoxide were located throughout the facility. At 11:00am they were tested and observed to be operational. At 11:10am, LPA toured the backyard and observed the facility has sufficient space and appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water, and the backyard is fenced all around. Between 11:30am to 1:30pm, LPA reviewed records of three (3) residents and three (3) staff. Resident and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500. No deficiency cited during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Feb 4, 2025

Type of visit: Prelicensing

At 10:00am Licensing Program Analysts (LPAs), Angela Panushkina, Perchui Milena Khurshudyan and Licensing Program Manager (LPM) Nichelle Gillyard conducted an announced Pre-Licensing visit to the above facility and met with Administrator, Maro Podrumyan and Licensee Karine Karapetyan. Fire Clearance was approved on 12/12/2023 for a maximum capacity of six (6) residents, of which four (4) Non-Ambulatory and one (1) bedridden residents in room #4. Facility was also approved for a Hospice waiver for six (6) residents on February 1st, 2024. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of team touring the physical plant inside and outside and observed the following: KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. At 10:30am, the team observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. Fire Extinguisher was last purchased on 10/31/23. BEDROOMS: There are four (4) bedrooms designated for client use. Bedroom #4 was furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. Facility will have awake staff. BATHROOMS: At 10:40am the team observed two and a half (2.5) bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured between 105°-106°F. observed appropriate grab bar and had non-skid mat. Continue on LIC809-C COMMON AREAS: The facility maintains a comfortable temperature at 73°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. The fireplace located in the dining room is adequately closed and inaccessible. MEDICATION: The medications will be kept in the kitchen cabinet and the team observed the cabinet kept locked and inaccessible to residents in care. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:45am they were tested and observed to be operational. SURROUNDING GROUNDS: In the back of the facility has sufficient yard space. The team observed appropriate outdoor furniture, with a covered shaded area for clients. The backyard is fenced. The team discussed the importance of maintaining the care and supervision to meet the needs of clients. There are no bodies of water. GARAGE: The attached garage is currently being used for storage. The team observe the garage locked and inaccessible to residents in care. In addition, the team observed laundry room is located in the garage. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Component III was conducted with the Administrator and the Licensee. Licensee was encouraged to sign up for sit alerts and guardian for future use and notifications. The Administrator was informed to notify the LPA regarding the first client/resident being admitted to the facility. The Administrator will also submit updated facility sketch indicating that the room #5 will be used for an Office/Staff room. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and with a copy of this report was provided to the Applicant/Administratorthe state’s words, verbatim · CDSS document, Feb 7, 2024