KLN Boarding Care

Type of visit: Required - 1 Year

At approximately 9:30 a.m. on 08/20/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and later the administrator and disclosed the reason for the visit. The facility was last visited on 07/02/2024 for a prelicensing inspection. It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen, garage, laundry room, common areas, outdoor space, and a pool. It has an approved fire clearance for six (06) residents, of which five (05) can be non-ambulatory and one (01) bedridden resident in bedroom #1. Approved hospice waivers for (06) residents. LPA entered through an unlocked door with a keypad. At the main entrance, LPA observed postings including but not limited to the facility’s nondiscrimination notice, theft and loss policy, personal rights, rights of resident councils, emergency disaster plan, and contacts for the Ombudsman and confidential complaints. At approximately 9:45 a.m. LPA measured the room temperature to be 77 degrees Fahrenheit. Cameras were observed on the exterior of the facility. Walls, floors, windows, screens, and blinds were clean and in good repair. The living room contained furniture in good repair, an appropriately covered fireplace, and reading materials. Puzzles, art supplies, and exercise equipment were stored in a hallway closet. The facility had four (04) bedrooms. All bedrooms contained a nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. At approximately 10:10 a.m. LPA observed the resident in Bedroom #2 with full bed rails. Interview with the administrator at approximately 10:45 a.m. revealed the resident is not receiving hospice services. A deficiency is issued on the corresponding LIC 809-D page for the retaining a resident with full bed rails without hospice services. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen refrigerator, freezer, and pantry. The garage was locked and inaccessible. At 10:25 a.m. LPA measured the refrigerator and freezer temperatures to be 40 and -3 degrees Fahrenheit, respectively. The stove hood and surface were clean. Appliances were in good condition. Sharps were locked under a counter. Medications were locked above the counter in a cabinet. Cleaning solutions were locked in the laundry area along with a fully-stocked first aid kit and a washing machine and dryer. At approximately 10:30 a.m. LPA observed a fully charged fire extinguisher in the kitchen. All emergency exit paths were free from obstructions. The exit gate was unlocked with a self-closing latch. At approximately 10:40 a.m. the dual-purpose smoke and carbon monoxide detector was tested and operational. Facility detectors are hard-wired and functioned simultaneously during the test. The fire door near the main entrance closed during the test as well. Three (03) out of three (03) auditory alarms were tested and functioning. The house telephone was called at 11:00 a.m. and deemed operational. The facility had two (02) bathrooms. Bathrooms contained liquid soap, paper towels, a trash can with a tight fitting lid, grab bars in the shower, and a non-skid mat in the shower. The toilet in Bathroom #1 did not have grab bars. A deficiency is issued on the corresponding LIC 809-D page for the lack of grab bars. At 12:40 p.m. LPA measured the water temperature in Bathroom #1 to be 114.0 degrees Fahrenheit. LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition and exercise equipment. The ramp which led out was secure. The pool was gated and locked to be inaccessible. A storage shed was locked and contained decorations. Around 11:30 a.m. LPA reviewed resident and personnel files. All resident and staff files were available but incomplete. Deficiencies are issued on the corresponding LIC 809-D for incomplete staff and resident files. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 20, 2025

Type of visit: Prelicensing

At 9:30am Licensing Program Analysts (LPA) Leizl de la Cerra conducted an announced Pre-Licensing Inspection to the above facility and met with Licensee Kathrine Nagapetyan. The LPA will inspect the facility to ensure that the facility is in compliance with the rules and regulations under California Code of Regulations, Title 22, Division 6. Fire Clearance was approved on 02/29/2024 for a maximum capacity of six (6) residents, of which five (5) are for non-ambulatory and one (1) for a bedridden resident in room #1. Facility was also approved for a Hospice waiver for six (6) residents on February 01, 2024. The facility is a single-story building. At 9:45am, with the assistance of the Licensee, LPA conducted a facility tour of both the inside and outside premises and observed the following: KITCHEN: The kitchen is equipped with a refrigerator, microwave oven and sink. At 9:50am, 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. The medications will be kept in the kitchen cabinet and LPA observed the cabinet is locked and inaccessible to residents in care. The first-aid kit is complete. There is a three drawer locked cabinet and will contain resident and staff records. The facility smoke alarm system is hard wired and interconnected. The fire extinguisher is located near the dining area and was observed to be fully charged and was last purchased on 02/27/24. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Alarms were tested and observed to be operational. BEDROOMS: There are four (4) bedrooms designated for client use. Bedrooms #2 #3 and #4 are cleared for five (5) non-ambulatory residents and bedroom #1 is cleared for one (1) bedridden. . All bedrooms are furnished with beds, night stands, chair, flashlights, caregiver pager/call button and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. BATHROOMS: At 10:25am LPA observed two (2) bathrooms that are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured between 112°- 115°F. observed the appropriate grab bars and have non-skid mats. 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 living room is adequately closed and inaccessible. SURROUNDING GROUNDS: At 10:35 LPA observed the back of the facility. There is sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There is a pool in the backyard which is fenced and locked, inaccessible to the residents. The fence surrounding the swimming pool is approximately 5 feet high all around. A key is needed to gain entry to the swimming pool as it is kept locked at all times. GARAGE: LPA observe the garage is separate from the house. The garage is locked and inaccessible to residents in care. LAUNDRY ROOM: LPA observed laundry room which has a lock and is located by the kitchen area. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use. Cleaning supplies were also kept in the laundry room which is inaccessible to clients. Component III Orientation was conducted with the administrator/applicant during the visit. LPA de la Cerra will notify the Centralized Applications Bureau (CAB) Analyst of the completed Pre-Licensing inspection. The CAB Analyst will notify applicant when license is approved. Exit interview was conducted and a copy of the signed report has been emailed to the applicant.the state’s words, verbatim · CDSS document, Jul 2, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Kathrine L Nagapetyan - Applicant and Erna Gevorgyan - Administrator Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 04/23/2024, 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, Apr 23, 2024