Dignity Senior Care

Allegation investigated: Staff did not ensure the provision of proper catheter care. Staff did not meet residents needs for services resulting in illness and/or injury. Staff did not maintain the facility in a clean, safe, and sanitary condition. Staff did not obtain timely medical care for residents. Staff did not provide required incontinence services. Staff did not ensure residents received sufficient nourishment.

Licensing Program Analyst (LPA) Michael Cava created this report to conclude the investigation regarding the above allegations. The initial visit to this investigation was made on 05/01/25 followed by a subsequent visit on 10/15/25. Since then, facility administrator had been excluded on 10/16/25 and facility closed on 03/06/26. No administrators were hired and available for interview since the administrator exclusion. Regarding Allegation: Staff did not ensure the provision of proper catheter care, it was reported that residents catheter bags were not getting emptied. Review of Resident 1’s (R1) records does reveal that R1 does not have the capacity to care for their toileting needs, but there is no indication that R1 required a catheter. During visit on 05/01/25, four (4) of four residents were interviewed. These residents deny the use of catheter. During subsequent visit on 10/15/25, six (6) of six residents deny the use of a catheter. R1 could not be interviewed during either visits, as R1 no longer resided at the facility at that time. Staff 1 (S1) Unsubstantiated was interviewed on 05/01/25, and stated that R1 required catheter care. S1 also stated that R1 was receiving hospice care at least five times per week. As part of the hospice services, catheter care was provided to R1. Administrator was unavailable for interview during either visits. Review of R1's records confirm hospice care, but there was no indication that R1 required catheter care, or listed anywhere on R1's records. Based on the information obtained through interviews and record review, it could not be proven that staff did not ensure the provision of catheter care. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding Allegation: Staff did not meet residents needs for services resulting in illness and/or injury and Staff did not obtain timely medical care for residents, it was reported that several residents in care were observed to decline because of neglect. R1 had an eye infection and staff did not observe any changes in her R1’s health condition and never notified R1’s responsible person of an infection. During visit on 05/01/25, LPA interviewed four of four residents, who deny their needs not being met. On 10/15/25, LPA interviewed six residents, who also deny their needs not being met. During both visits, residents that were interviewed did not express any complaints or concerns regarding their care and supervision. Interview with S1 deny not being able to meet resident needs. Administrator was unavailable for interview during either visits. Based on the information obtained through interviews and record review, it could not be proven that Staff did not meet residents needs for services resulting in illness and/or injury and Staff did not obtain timely medical care for residents, Therefore, the allegations are deemed Unsubstantiated at this time. Regarding Allegation: Staff did not maintain the facility in a clean, safe, and sanitary condition, it was reported that residents rooms are all malodorous, residents were being left dirty, and residents are being left in dirty bedsheets as well. During LPA visits on 05/01/25 and 10/15/25, LPA conducted a physical plant inspection to insure the health and safety of the residents in care. During those visits, LPA did not observe any physical plant violations pertaining to title 22. Moreover, on 09/24/25, an annual required inspection was made. No deficiencies were observed regarding the physical plant not being clean, safe and in a sanitary condition. Interviews with four residents were made on 05/01/25 and six residents on 10/15/26. These residents expressed no complaints or concerns to corroborate with the allegation. Based on the information obtained through interviews and record review, it could not be proven that Staff did not maintain the facility in a clean, safe, and sanitary condition. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding Allegation: Staff did not provide required incontinent services, it was reported that residents were being left in soiled diapers for extended periods of time. Interviews with four (4) of four residents made on 05/01/25 and six (6) of six residents made on 10/15/26 do not corroborate with the allegation. Interview with some of these residents indicate that they can go to the bathroom on their own, and the other residents, that need incontinent care, state that their needs are met. Interview with S1 also deny the allegation, stating incontinent care is being provided to residents in need. Based on the information obtained through interviews and record review, it could not be proven that Staff does not provide required incontinent services. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding Allegation: Staff did not ensure residents received sufficient nourishment, it was reported that residents were being left without any fluids to drink. Interviews with four (4) of four residents made on 05/01/25 and six (6) of six residents made on 10/15/26 do not corroborate with the allegation. These residents expressed no complaints or concerns about not getting enough fluids to drink for sufficient nourishment. Interview with S1 deny the allegation, stating when a resident requires fluids, or something to drink, it gets provided to them. Based on the information obtained through interviews and record review, it could not be proven that Staff did not ensure residents received sufficient nourishment. Therefore, the allegation is deemed Unsubstantiated at this time. A copy of this report is mailed to the licensee’s last known mailing address on file.the state’s words, verbatim · CDSS document, Jul 16, 2026 · control 31-AS-20250424105244

Allegation investigated: Staff did not notify authorized representative of resident’s relocation

Licensing Program Analyst (LPA) Michael Cava created this report to conduct a complaint investigation regarding the above allegation. RO conducted a phone call with Licensee’s representative and informed them of the reason for this report. On 3/12/26, LPA Cava conducted a telephone interview with responsible party. Regarding allegation: Staff did not notify authorized representative of resident’s relocation: It’s being alleged that Resident 1 (R1) was relocated to a hospital and their responsible party was not notified. Per interview conducted with R1’s responsible party (RP) it was revealed RP was unable to locate R1 for two days. RP stated that on 3/4/26, R1’s home health nurse went to the facility to provide services, but no one answered the door and facility appeared to be empty. On or around 03/05/26, RP was informed that R1 is at the Unsubstantiated hospital, and hospital staff were informed that R1 had no family members to contact. RP attempted to contact facility’s licensee several times to obtain R1’s medication and personal belongings, but licensee has not responded or returned RP’s phone call as of 3/12/26. Based on the information obtained there was insufficient evidence to corroborate the allegation of staff not notifying an authorized representative of the resident’s relocation. Therefore, the allegation is Unsubstantiated. Exit interview was conducted with Licensee’s Representative and a copy of this report was emailed. A copy of this report is mailed to the licensee’s last known mailing address on file.the state’s words, verbatim · CDSS document, Jul 8, 2026 · control 31-AS-20260306151236

Allegation investigated: Licensee did not provide a refund to residents

Licensing Program Analyst (LPA) Michael Cava created this report to conduct a complaint investigation regarding the above allegation. RO conducted a phone call with Licensee’s representative and informed them of the reason for this report. Regarding allegation: Licensee did not provide a refund to residents, it was reported that Resident 1 (R1) Resident 2 (R2), and Resident 3 (R3) are unable to provide payment for a new care facility as they paid Dignity Senior Care at the beginning of the month and a refund for their fees pay was not provided to them. On 03/12/26, LPA Cava called R1’s family, who stated R1 is still at the hospital at that time, but no refund from facility has been issued. On 03/17/26, a LPA conducted a collateral visit to a hospital where the residents were staying at, to obtain Substantiated additional information of the resident whereabouts, contact information and if Dignity Senior Care issued them a refund. According to a Social Worker (SW) there, all three residents have been discharged, but no refunds issued for each residents. LPA proceeded to call the residents and their family members, who all confirmed that since leaving the facility, the licensee has not issued a refund. Based on the information obtained, the allegation of licensee not providing a refund to residents is Substantiated. Citation issued on the 9099D. Appeal rights and a copy of this report issued. A copy of this report is mailed to the licensee’s last known mailing address on file.the state’s words, verbatim · CDSS document, Jul 7, 2026 · control 31-AS-20260310121404

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5) · Plan of correction due date: Mar 17, 2026

Admission Agreement: Refund conditions- (C) The licensee shall refund any prepaid monthly fees to a resident or the resident’s representative, if any, as follows: the licensee surrenders the license or the licensee abandons the facility. This requirement was not met as evidenced by: On 03/17/26, calls were made to the resident and their families confirming that no refunds had been issued since the residents left facility on 03/03/26.the state’s words, verbatim · CDSS document, Jul 7, 2026

Plan of correction: The Department is unable to issue a POC since the licensee had abandoned the facility.

Type of visit: Case Management - Deficiencies

This report was created to correct information and deficiency on the report made on May 21, 2026. Licensing Program Analyst (LPA) Michael Cava conducted a case management visit to address deficiency observed during complaint investigation visit for complaint # 31-AS-20260119231501. During the investigation it was revealed that Resident 1 (R1) had a fall on the night of 01/16/26, but facility staff did not call or sought medical attention after the fall. R1’s responsible party arrived the morning of 01/17/26 at around 10:00am and sought emergency services for R1. As a result, R1 sustained a broken hip and dislocated shoulder. Interview with Staff 1 (S1) confirmed paramedics were not called immediately to treat R1 for their fall. When S1 was questioned why 911 emergency services were not called, S1 stated they were not called for fear that licensee/operator would be upset. S1 did what they could’ve done best, by staying alongside R1 until R1’s responsible party can call 911. A citation will be issued on the 809D for failure to provide adequate care. Appeal Rights, copy of LIC809/809D, were mailed to the licensee’s last known mailing address.the state’s words, verbatim · CDSS document, May 22, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: May 22, 2026

Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis...This requirement is not met as evidenced by: Based on interviews conducted on the night of 01/16/26, R1 had a fall and staff did not seek medical attention until the following morning of 01/17/26, when R1's family called 911. This posed an immediate risk to the health, safety, and personal rights of the people in care. evidenced by: Based on interviews conducted on 01/16/26, R1 had a fall and staff did not seek medical attention until the following morning of 01/17/26, when R1's family called 911. This posed an immediate risk to the health, safety, and personal rights of the people in care.the state’s words, verbatim · CDSS document, May 22, 2026

Plan of correction: POC: Facility is closed as of 03/16/26. Therefore no POC was created at this time.

Allegation investigated: Staff did not provide adequate care and supervision to the residents

This report supersedes report dated 3/3/26 and that the report was amended to remove confidential information. Regarding the Allegation: Staff did not provide adequate care and supervision to the residents. It is alleged staff left R1 on the bathroom floor alone after a fall. Interviews revealed that R1 had a fall on the night of 01/16/26. S1 did not obtain medical services for R1. Instead, S1 stayed with R1 until the following morning, when the family arrived at approximately 10:40am, to call the paramedics. R1 was taken to the hospital, requiring surgery for a broken hip and dislocated shoulder. S1 stated to not have call 911 as they were scared to get in trouble. S1 did what they could’ve done best, by staying alongside R1 until family can call 911. Based on information obtained during that visit, the above allegation was Substantiated. Additional information was received during an interview with Resident #1(R1)’s responsible party on 03/03/26 after the visit which revealed S1 had stayed with R1, did not leave R1 alone, and was present to provide supervision.Based on this review, although proper care was not provided to R1, there was evidence that S1 stayed with R1, after they experienced a fall, to provide some sort of supervision. Therefore, the allegation of staff not providing adequate care and supervision to the resident is deemed Unsubstantiated at this time. A copy of this report LIC 9099 was mailed to the licensee’s last known mailing address. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 21, 2026 · control 31-AS-20260119231501

Type of visit: Case Management - Deficiencies

This report is being created to address an incident pertaining to complaint control # 31-AS-20260119231501. . It was reported that Resident 1 (R1) had a fall the night of 01/16/26, but facility did not provide immediate medical attention after the fall. As a result, R1 sustained a broken hip and dislocated shoulder. Interview with Staff 1 (S1) confirmed paramedics were not called immediately to treat R1 for their fall. When S1 was questioned why 911 emergency services was not called, S1 stated they were not called for fear that licensee/operator will be upset and threaten them, like before. S1 did what they could’ve done best, by staying alongside R1 until family can call 911. Although S1 remained by R1 to provide some support after R1’s fall, immediate medical attention was not provided to R1, as R1 sustained a serious injury as a result of this fall. A citation will be issued on the 809D for failure to provide adequate care. This report was mailed to the last known licensee address.the state’s words, verbatim · CDSS document, May 21, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: May 21, 2026

Personnel Requirements - General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: On the night of 01/16/26, R1 had a fall and was not provided immediae medical attention until the followng morning of 01/17/26, when R1's family called 911. This posed an immediate health and safety risk to the resident in care.the state’s words, verbatim · CDSS document, May 21, 2026

Plan of correction: Facility is now closed therefore no POCs will be issued at this time.

Allegation investigated: Staff are not providing adequate food service to residents

This is a corrected version of report dated 9/17/25 to note correct deficiency on LIC 9099D for deficiency noted on 9/17/26. It was reported that the facility food service only consists of serving cold cuts, hot links, hot dogs, and other assorted frozen meats. There is no variety of fresh food being provided to the residents in care. Investigation consisted of a physical plant inspection/inspection of food supply, conducted between 11:50am to 12:30pm. LPA interviewed Staff 1 (S1) between 12:30pm and 1:00pm. Interviews with five (5) of five residents between 1:00pm to 2:00pm. Interviews made with two (2) out of five (5) residents stated they were okay with the food. During a physical plant inspection, LPA Cava observed a lack of fresh/perishable foods items that should be adequate for two (2) days. LPA confirmed food storage only consisted of cold cuts, hot dogs and hot links. No fresh fruits or vegetables observed. Based on this observation, the above allegation is Substantiated. Substantiated that staff can do the laundry. In addition to not buying the laundry detergent, the licensee is not paying staff their wage. Interview with one (1) of one staff regarding their pay could not confirm the allegation, but note this staff was just hired. Interview with this same staff also deny not meeting the residents laundry needs as staff was doing laundry on the day of the investigation. LPA was unable to interview administrator at this time, as administrator was unavailable on 09/24/25. LPA was unable to review facility finances and bank statements as staff did not have access to the licensee financial documents to verify sufficient funding. LPA did observe utilities, water, gas and electricity, to be in running order during the day of this investigaiton. Based on the information obtained through interviews and observation, it could not be proven that the facility was in financial distress. Moreover, financial records could not be obtained for review as the facility has since closed on March 16, 2026. Therefore, the allegation is deemed Unsubstantiated.the state’s words, verbatim · CDSS document, May 5, 2026 · control 31-AS-20250916083845

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(a) · Plan of correction due date: May 5, 2026

General Food Service Requirements. The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. This requirement was not met as evidenced by: During a plant inspection of the facility food supply, LPA did not observe an adequate amount of perishable foods. This poses an immediate health and safety risk for the residents in care.the state’s words, verbatim · CDSS document, May 5, 2026

Plan of correction: No corrections required at this time as facility has closed on March 16, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda, along with Licensing Program Manager (LPM) Mary Flores, and Regional Manager (RM) Angela Whittaker, conducted an unannounced Case Management Visit at this facility. RM, LPM, and LPA upon arrival there was no one at the facility. The purpose of the visit is to issue one (1) Temporary Suspension Orders (TSO). The TSO's effective date is the close of business hour today. The TSO is for DIGNITY SENIOR CARE INC. located at 10421 GERALD AVE, GRANADA HILLS CA 91344 (#197610582). During the visit, there were no residents in the facility. All residents were relocated from this location to Holy Cross Providence Medical Center on 3/3/2026. Copy of appeal rights will left with this report. Packet will be left at the mailbox and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 6, 2026

Allegation investigated: Staff did not provide adequate care and supervision to the residents

This is an amended report to the complaint investigation, that was conducted on 02/18/26. Based on the information obtained then, there was insufficient evidence to corroborate the above allegation. During this visit, made on 03/03/26, Licensing Program Analysts (LPAs) LPAs Antonia Alvizar-Etima, Nicholas Reed and Michael Cava, along with Licensing Program Manager (LPM) Naira Margaryan, obtained additional information pertaining to the above allegation, which is as follows: - Resident 1 (R1) had a fall the night of 01/16/26. - Staff stayed with R1 all night, but was afraid to call paramedics for fear, possibly from the licensee becoming upset with them - Staff did notify family, who came first thing in the morning. - Family came on the morning 01/17/26, and at approximately 10:40am, paramedic were called. - R1 was taken to the hospital, requiring surgery for a broken hip and dislocated shoulder. Substantiated - R1 is currently at a nursing facility for rehabilitation. - R1 will not be returning to the facility. - Interview with staff corroborates with the incident of R1 having a fall, but paramedics were not called for fear that licensee/operator will be upset and threaten them, like before. Based on the additional information obtained, the allegation of staff not providing adequate care and supervision is Substantiated. Citation(s) issued on the 9099D. A copy of this report issued.the state’s words, verbatim · CDSS document, Mar 3, 2026 · control 31-AS-20260119231501

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Mar 3, 2026

Personnel Requirements - General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: On the night of 01/16/26, R1 had a fall and was not provided immediate medical attention until the followng morning of 01/17/26, when R1's family called 911. This posed an immediate health and safety risk to the resident in care.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: R1 is no longer at the facility, therefore, no POCs will be issued at this time.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Mar 3, 2026

Reporting Requirements: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This was not met as evidenced by: During file review, no Incident Report was submitted for R1's fall on 01/16/26.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: R1 is no longer at the facility, therefore, no POCs will be issued at this time.

Allegation investigated: Facility does not maintain an adequate food supply Lack of supervision resulted in resident AWOL

Licensing Program Analysts (LPA) Antonia Alvizar Ettima, Nicholas Reed, Michael Cava and Licensing Program Manager LPM Naira Margaryan conducted unannounced licensing visit to the facility. LPAs and LPM met the facility staff and informed about the purpose of this visit. The investigation of the above noted allegations was initiated on 02/18/16 by LPAs Michael Cava and Leslie Ngo-Castaneda. During initial visit LPAs inspected the facility and reviewed facility food supply. At 9:45 AM LPA spoke with staff #1 (S1) and obtained pertinent information regarding the allegations. At 10:00 AM, LPAs requested residents and staff roster and conducted facility inspection to ensure that residents’ health and safety is protected. At (time) LPA Alvizar-Ettima requested and reviewed residents records, included but not limited to Physician report, need and service plan and other documents. Facility does not maintain an adequate food supply. It was alleged that the facility does not have enough food for residents. Staff would purchase food for Substantiated Cont. from LIC-9099 residents and would not be reimbursed. The refrigerator was checked and there was only food for 1 resident brought by the family member. On 02/18/2026, upon facility inspections LPAs noted that facility does not have sufficient quantity and variety of perishable and nonperishable food supply. Refrigerator was almost empty. Staff verified that facility has low food supply. S1 stated that they were buying the food out of her pocket and was not getting reimbursed. All facility residents were interviewed during Case management visit that was conducted in conjunction with complaint investigation and they address their concerns about food service and insufficient food supply. At the time of this visit at 8:40a.m. LPA Alvizar – Ettima also spoke with the staff and residents and they revealed the same information as during initial visit. Based on inspection, observation and interviews it was concluded that the facility has insufficient food supply. Therefore, the allegation is SUBSTANTIATED at this time. Lack of supervision resulted in resident AWOL It was alleged that a several residents wandered away from the facility and a missing person report was filed. Resident was found down the street by law enforcement. At the time of this visit at approximately 10:00a.m. LPA Alvizar- Ettima spoke with staff and they stated that residents had mental issues and walked out the door. Upon inspection, it was observed that there was only one (1) staff during the times residents AWOL. Residents resided at the facility for several days. S1 indicated that they ran out looking for residents in the street and did not find them. S1 did not have the resident’s facility file. At 10:40a.m. residents present at the facility were interviewed and they had no knowledge about any residents wandering away from the facility. Facility did not have resident’s facility records at the time of this visit. Based on inspection, observation and interviews there is a sufficient information to verify the allegation. Therefore, the allegation is Substantiated at this time. Cont. from LIC -9099A It was alleged that there are not enough staff to bathe residents. Residents are getting “towel cleaning”. Staff #1 (S1) stated that she provides showers to all residents. At times she may clean residents with wet towels if needed. Residents interviewed during investigation did not address any concerns regarding their hygiene assistance. The residents observed during initial and subsequent visit were clean and groomed. Based on interviews and observation there is no sufficient information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.the state’s words, verbatim · CDSS document, Mar 3, 2026 · control 31-AS-20260213133913

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Mar 3, 2026

87555 General Food Service Requirements (b)(26). The following food service requirements shall apply: Supplies of nonperishable foods for a minimum of 1 week & perishable foods for a mini. of two days shall be maintained on the premises. This requirement is not met as evidenced by: The licensee failed to ensure to maintain sufficient quantity and variety of food supply. This posses a potential hazard to health, safety and personal right for residents in carethe state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: There is no residents longer in the facility, no POC's will be issued at this time

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(d)(f)(1) · Plan of correction due date: Mar 3, 2026

Basic Services(d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility responsible for meeting…& providing the other basic services…(f) Basic services shall ... include:(1) Care & supervision. This requirement is not met as evidenced by. The Licensee failed to provide appropriate care and supervision to the resident that is unable to leave facility unattended, Thia poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: There is no residents longer in the facility, no POC's will be issued at this time

Type of visit: Case Management - Deficiencies

At approximately 9:00 a.m. on 03/03/26, Licensing Program Manager (LPM) Naira Margaryan and Licensing Program Analysts (LPAs) Michael Cava, Antonia Alvizar-Ettima, and Nicholas Reed conducted an unannounced case management visit in conjunction with a subsequent complaint visit. LPAs and LPM met with Staff #1 (S1) and disclosed the reason for the visit. Today’s case management visit was conducted to address previously noted concerns noted in the facility. On 10/20/25 the Department issued an order of immediate exclusion for the facility administrator Lala Soghomonyan. LPAs Michael Cava and Jose Gary Tan hand-delivered the immediate exclusion letter to staff Matthew Caceres. Matthew informed LPAs that the Licensee was in the process of hiring a new certified administrator to oversee facility operations. During that visit, LPAs noted various Title 22 deficiencies and issued citations and civil penalties. On 02/18/26 LPAs Michael Cava and Leslie Ngo-Castaneda conducted another Case Management visit to the facility to ensure a new Administrator was hired. Between 8:30 a.m. and 10:00 a.m. on 02/18/26 LPAs interviewed S1 and four (04) residents. Nobody knew who the licensee or administrator were. Between 9:30 a.m. and 10:30 a.m. on 02/18/26 LPA Cava made multiple attempts to contact the licensee on file but received no response. On 02/26/26 LPA Cava made a Case Management visit and met with the same facility staff, S1. All residents were observed still residing in the facility. Additional civil penalties were issued. S1 was again reminded that all residents must be relocated. No deficiencies were corrected as of 02/26/26 and today. Additional civil penalties were issued for repeat violations and fire clearance violations. LPA Cava issued a “7-day notice of closure” to the Licensee via regular and certified mail and email, informing that the Licensee must contact the Department within seven (07) days. Failure to respond would consider the license forfeited. Licensee abandonment of the facility posed an immediate risk to the Health and Safety of the residents in care. Since 10/28/25 the facility operated without a qualified administrator. The Department received no response from the 7-day closure notice. Based on the information above, it is concluded that the facility is abandoned and the license shall be forfeited by operation of the law. A Notice of Violation of the Law (NOVL) Letter was issued to S1 along with a copy of today’s report. The NOVL letter was also emailed to the facility email address on file. Additional deficiencies issued from today’s visit include deficiencies for administrator qualification and duties and acceptance and retention limits. LPAs and LPM were unable to contact the licensee after multiple attempts between 9:00 a.m. and 1:00 p.m. today. LPM Margaryan spoke to the father of the licensee at 10:30 a.m. to discuss the staffing situation at the facility. LPM was informed no other staff could come to the facility and the licensee did not want further involvement with the facility. A citation was issued under Health and Safety Code 1569.19(1) for facility abandonment by the Licensee. The staff was advised that all residents must be relocated from the facility within two weeks. LPAs interviewed three (03) residents and S1 between 9:00 a.m. and 11:30 a.m. Around 11:15 a.m., Resident #1 (R1) indicated that they had not received medication for their diabetes since admission three weeks ago. R1 also had been left in feces since yesterday, 03/20/26. Interview with S1 at 11:30 a.m. confirmed they had not yet changed R1 because they had a large sore on their back that was infected and contagious. R1 called 9-1-1 at approximately 12:45 p.m. Paramedics assessed R1 and two (02) other residents. Since S1 packed up their belongings and stated they were ready to leave the facility, residents were considered abandoned and neglected. All three (03) residents were transported to the hospital. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.682(a) · Plan of correction due date: Mar 4, 2026

§1569.682 Transfer of resident upon forfeiture of license... (a) A licensee... shall... take all reasonable steps to transfer affected residents safely and to minimize possible transfer trauma. This requirement was not met as evidenced by: The licensee did not comply with the section cited above by not assisting the relocation of three (03) residents which posed an immediate risk to the Health, Safety, or Personal Rights on persons in carethe state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: The Department was unable to contact the Licensee. All residents were relocated as of 3:00 p.m. today.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.682(e) · Plan of correction due date: Mar 4, 2026

§1569.682 Transfer of resident upon forfeiture of license... (e) A licensee... shall be liable for the imposition of civil penalties in the amount of one hundred dollars ($100) per violation per day for each day. This requirement was not met as evidenced by: The licensee did not comply with the section cited above by not assisting the relocation of three (03) residents which posed an immediate risk to the Health, Safety, or Personal Rights on persons in carethe state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: The Department was unable to contact the Licensee. All residents were relocated as of 3:00 p.m. today. Civil penalties assessed since 02/26/26.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Mar 4, 2026

87202 Fire Clearance (a) All facilities shall... obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: The licensee did not comply with the section cited above by not acquiring a non-ambuatory fire clearance for at least two (02) residents which posed an immediate risk to the Health, Safety, or Personal Rights on persons in carethe state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: The Department was unable to contact the Licensee. All residents were relocated as of 3:00 p.m. today. Civil penalties assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(c) · Plan of correction due date: Mar 4, 2026

87405 Administrator - Qualifications and Duties (c) Failure to comply with all licensing requirements pertaining to certified administrators may constitute cause for revocation of the license of the facility. This requirement was not met as evidenced by: The licensee did not comply with the section cited above by not hiring a qualified administrator since the exclusion of the former administrator in October 2025 which posed an immediate risk to the Health, Safety, or Personal Rights on persons in carethe state’s words, verbatim · CDSS document, Mar 3, 2026

Plan of correction: The Department was unable to contact the Licensee to create a Plan of Correction.

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Leslie Ngo and Michael Cava conducted a Case Management visit to facility to follow up and see if the licensee has hired a qualified administrator, Plan of Corrections (POCs) issued on 02/18/26 and if the licensee is in receipt of the seven day letter mailed on 02/24/26. LPAs also conducted a physical plant inspection and health and safety check to insure facility compliance to title 22 (made between 10:11am - 10:50am), and interviews with residents and record review (10:50am - 11:45am). Based on observation, Licensee has failed to correct POCs. Moreover, additional deficiencies were observed. Citations issued on the 809Dthe state’s words, verbatim · CDSS document, Feb 26, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87761(f) · Plan of correction due date: Mar 4, 2026

Penalties: If any deficiency is not corrected by the date specified in the notice of deficiency, a penalty shall be assessed for each day following that date until compliance has been demonstrated. This requirement was not met as evidenced by: During today's CM visit, LPAs observed that the bathroom door knob and broken dressers have not been reppaired. Moreover, the licensee has yet put in place a qualified administrator. Pursuant to 87761(a), A penalty of $50 per day, per cited violation, shall be assessed for deficiencies that were not corrected by the POC datethe state’s words, verbatim · CDSS document, Feb 26, 2026

Plan of correction: As POC, licensee will correct these deficiencies by 03/04/26. As proof deficiencies are corrected, the licensee will submit documentations that a qualified administrator is put in place. Licensee will also submit photos that the door knob and broken dressers are repaired.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87555(b)(26) · Plan of correction due date: Feb 26, 2026

General Food Service Requirements: Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: During physical plant inspection, facility lacked a sufficient supply of perishabe and non-perishable foodthe state’s words, verbatim · CDSS document, Feb 26, 2026

Plan of correction: As POC, the licensee will purchase a sufficient supply of perishable and non-perisahble food today (02/26/26). Proof of this correction via photos or receipt will be submitted to the licensing agency by March 5, 2026.

Allegation investigated: Staff is refusing to take resident back into care.

Licensing Program Analysts (LPAs) Leslie Ngo-Castaneda and Michael Cava conducted an initial complaint visit to the facility to investigate the above allegation. LPAs met with the staff Emma Rodriguez, and advised them about the visit. An entrance interview was conducted. To investigate the allegation, at 10:00 AM LPAs conducted a physical plant tour to ensure the health and safety of the clients in care, LPAs interviewed four (4) residents, one (1) staff from 8:45-10:00 AM. At 11:00 AM, LPA reviewed and received copies of documents about the investigation for R1: staff roster (LIC 500) and resident roster (LIC 9020). R1 has only been only at the facility for a day. In addition, at 2.13.2026 at 3:38 PM LPA made a phone contact to hospital Social Worker to obtain additional information about R1’s health condition. Continue to LIC 9099-C Unsubstantiated Allegation: Staff is refusing to take resident back into care It is being alleged that the Resident #1 (R1) was abandoned in the hospital and cannot return to the facility. Information received revealed that Resident #1 (R1) was taken to the hospital on 2.6.2026 because of their level of care. Staff and residents interview revealed that R1 was violent and vicious towards other residents in the facility. Staff indicated that the hospital planner attempted to discharge R1 back to the facility. However, R1’s health conditions were not compatible and their presence at the facility would continue to pose hazard to other residents and staff. Upon further discussion with the hospital social worker and other medical professionals the decision was made that R1 will not be returning to the facility and will be discharge to another facility for higher level of care. LPA interviewed three (3) out of four (4) residents who confirmed that R1 has been physically and verbally violent towards other residents and staff. Interview with SW verified the information received from the Facility staff. A review of facility records verified the information revealed from the interview. Based on interviews and record review there is no sufficient information to support the allegation. Therefore, this allegation is deemed unsubstantiated at this time.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 31-AS-20260209103034

Type of visit: Case Management - Other

In conjunction with complaint control # 31-AS-20260119231501, Licensing Program Analysts (LPAs) Leslie Ngo-Casteneda and Michael Cava conducted a Case Management (CM) visit to confirm who is the designated administrator for this facility. On 10/20/25, an Immediate Exclusion was issued for the facility administrator at that time, not to be present at any child care or residential facility, licensed by the Department. LPA Cava conducted a CM visit on 10/28/25 to follow up on Plan of Corrections (POCs) that was issued during an annual inspection that was made on 09/24/25. During that visit, LPA Cava was told by the house manager, licensee is in the process of hiring a new administrator. To this date, licensee has yet to submit information for the designated administrator for this facility. Today's CM visit consisted of interviews with one staff and four residents. Based on these interviews, it was determined that the licensee has failed to put a qualified administrator in place as four residents reveal they do not know who is in charge. Staff also could not confirm who the administrator is. Therefore a citation for not having a qualified administrator will be issued today. Staff is advised to notify the person they report to that LPAs will be returning to issue a Notice of Violation of Law (NOVL) and assessing an Immediate Civil Penalty on a later date. In addition to this citation, there were some deficiencies observed during a physical plant inspection and citations will also be issued on the LIC 809D.the state’s words, verbatim · CDSS document, Feb 18, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.19 · Plan of correction due date: Feb 18, 2026

Renewed period; filing of renewal application; forfeiture by operation of law (f) The licensee abandons the facility. A licensee who abandons the facility and the residents in care resulting in an immediate and substantial threat to the health and safety of the abandoned residents, in addition to forfeiture of the license pursuant to this section, shall be excluded from licensure in facilities licensed by the department without the right to petition for reinstatement. This requirment was not met as evidenced by, Licensee failing to place a qualified administrator since 10/20/25.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Facility has been deemed abandoned, and instructed to relocate their residents within two weeks. Staff advised to inform the person in charge that LPA Cava will be returning to issue an NOVL and an immediate civil penalty.

From the deficiency page — Deficiency type: Type A · Section cited: HSC87309(a) · Plan of correction due date: Feb 18, 2026

Storage Space: he licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended: This requirment was not met as evidenced by during a physical plant inspection, LPAs observed cleaning supplies in the bathroom and aerosol freshener in resident room that was accessbile to the residents in care. LPAs also observed cleaning supplies unlocked underneath the kitchen sink.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: As POC, staff stored and locked the cleaning supplies and aerosal freshener. No additional corrections needed

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Feb 18, 2026

Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: During a physical plant inspection LPAs observed a broken door knob in the resident bathroom and broken dressers utilzed by the residents for their personal belongings.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: As POC, licensee will repair the door knob and resident dressers and submit proof via photo that the door knob and dressers have been fixed. POC is due by 02/25/26 to the licensing agency.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Michael Cava conducted a Case Management (CM) visit to the facility to follow up on citations issued on 10/15/25. LPA met with the House Manager, Matthew Caceres, and advised him of the visit. On 10/15/25, LPAs Jose Gary Tan and Cava conducted a Case management visit to the facility to follow up on citations issued on a Required Annual visit that was made on 09/24/25. Citations on that visit were addressed, but during visit on 10/15/25, additional deficiencies were observed and the facility was cited for the following: Section 87303(a)- Maintenance and Operation: LPAs observed toilet seat not installed on the toilet in bathroom 1. Section 87458(a)- Medical Assessment: R1 did not have a Medical Assessment on file. Section 87507(a)- Admission Agreement: R2 did not have an Admission Agreement on file. Section 87412(a)- Personnel Records: S1 did not have a complete LIC 503/Health Screening. Today's CM visit consisted of a physical plant inspection, made between 10:30am to 11:30am, interviews with staff and residents, made between 11:30am to 12:30pm, and record review, made between 12:30pm to 1:30pm to address these citations and insure the health and safety of the residents in care. Per inspection, the above citations are cleared and have been addressed. Matthew was advised and a copy of this report issued. Matthew also stated the licensee is in the process of searching and hiring a new administrator in place of the current one on file.the state’s words, verbatim · CDSS document, Oct 28, 2025

Type of visit: POC

Licensing Program Analysts (LPAs) Jose Gary Tan and Michael Cava conducted a Case Mangement (CM) visit to the facility to follow up on a Plan of Correction (POC) issued on 09/24/25 pursuant to section 87555(b)(26) of the regulation. LPAs met with staff, Atri Shoun, and advised him of the visit. The administrator, Lala Soghomonyan, joined after. During an annual and complaint visit that was made on 09/24/25, LPA Cava did not observe a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises to correct a citation that was previously issued. Licensee was issued this citation previously on 09/17/25, but failed to correct it by the POC date of 09/23/25. Licensee was cited again on 09/24/25, and issued a civil penalty for failure to correct. Today's visit is to insure correction is made. The visit consisted of interviews with staff and residents. LPAs also conducted a physical plant inspection to insure food supply is sufficient. Per LPAs observation, the licensee is compliant to section 87555(b)(26). LPAs observed a minimum supply of one week non-perishable foods and a minimum supply of perishable food items for two days maintained on the premises. Based on this observation, Citation will be cleared. Staff advised and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 15, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Jose Gary Tan and Michael Cava conducted a Case Management (CM) visit to the facility to follow up on deficiencies that were issued during an annual that was made by LPA Cava and Angela Panushkina on 09/24/25. LPAs met with staff, Atri Shoun, and advised him of the visit. The administrator, Lala Soghomya, joined after. During the visit on 09/24/25, the licensee was cited for the following: Section- 87202(a)(1) Fire Clearance. LPAs Panushkina and Cava identified four (4) residents that were non-ambulatory. The facility is licensed for six (6) ambulatory only Section 87355(e)(1) Criminal Record Clearance. LPAs Panushkina and Cava conducted a file review and identified Staff 1 (S1) not being associated to the facility and also not carrying a fingerprint clearance Section 87506(a) Resident Records- Licensee was not able to provide resident records for LPA's review during the annual inspection that was made on 09/24/25 Section 87412(a) Personnel Records- Licensee was not able to provide staff records for LPA's review during the annual inspection that was made on 09/24/25. During today's visit, LPAs observed that section 87355(e)(1) has not been cleared by the licensee. Immediate Civil Penalties for Failure to Correct and Repeat Violation will be issued today, retroactive from 09/25/25 to 10/15/25 this citation (see LIC 421FCs from the annual visit made on 09/24/25 for total amount due). In addition, the following citations are issued on the LIC 809D. Licensee advised that Civil Penalties will continue to accrue until section 87355(e)(1) is corrected.the state’s words, verbatim · CDSS document, Oct 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 22, 2025

Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: During physical plant inspection, LPAs observed toilet seat not installed on the toilet in bathroom 1. This posed a potential health & safety risk.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: As POC, licensee will install a toilet seat to the toilet in bathroom 1. As proof POC is made, licensee will submit a photo to the licensing agency by 10/22/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Oct 22, 2025

Medical Assessment: Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional. This requirement was not met as evidenced by: During file review, R1 did not have a Medical Assessment on file.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: As POC, the licensee will obtain R1's medical assessment and maintain this on file. As proof POC is made, licensee will submit a copy to R1's medical assessment to the licensing agency by 10/22/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR87507(a) · Plan of correction due date: Oct 22, 2025

Admission Agreement: The licensee shall complete an individual written admission agreement, as defined in Section 87101(a). This requirement was not met as evidenced by: During file review, R2 did not have an Admission Agreement on file.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: As POC, the licensee will have R2's Admission Agreement completed and maintained on file. As proof POC is made, licensee will submit a copy of R2's Admission Agreement to the licensing agency by 10/22/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a)(11) · Plan of correction due date: Oct 22, 2025

Personnel Records: Each personnel record shall contain the following information: A health screening as specified in Section 87411. This requirement was not met as evidenced by: During file review, S1 did not have a complete LIC 503/Health Screening.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: As POC, the licensee will have S1 hve their health screening done with the LIC 503 completed. As proof POC is made, licensee will submit a copy of S1's LIC 503 to the licensing agency by 10/22/2025.

Allegation investigated: Staff did not ensure that hazards were inaccessible to residents in care. Staff did not ensure that food items were labeled. Facility is in disrepair. Staff did not ensure that records were kept confidential.

Licensing Program Analysts (LPAs) Angela Panushkina and Michael Cava conducted a complaint visit to this facility to investigate the above allegations. In conjunction to this complaint, complaint investigation (control # 31-AS-20250916083845) and a Required Annual Inspection was also made. LPAs met with staff, Emma Rodriguez, and advised her of the complaint. Today's investigation consisted of a physical plant inspection (conducted between 9:00am-10:00am), interviews with residents and staff (conducted between 10:00am-11:00am), review of medications & medication records (conducted between 11:00am-12:00pm) and interviews with staff and residents (conducted between 12:00pm-1:00pm). Investigation is as follows: Staff did not ensure that hazards were inaccessible to residents in care: In regards to the allegation, it was reported that cleaning supplies, toxins, knives, sharps and hazardous items/objects were not stored and locked to keep inaccessible to the residents in care. A visit made by another enforcement/and or advocate agency, conducted on 07/09/25 observed knives and sharps Substantiated in an unlocked kitchen drawer, cleaning supplies and hazardous toxins unlocked in a kitchen cabinet, centrally stored medications in the refrigerator and kitchen cabinet, not locked and secured. Pictures were included to this complaint revealing what was observed accessible on that day of the visit. Based on a review of the report and pictures submitted by this agency, as a credible witness, the allegation of staff not ensuring that hazards were inaccessible to residents in care is Substantiated. Citation issued on the 9099D. Staff did not ensure that food items were labeled In regards to the allegation, it was reported that the facility food items were not properly sealed and labeled. A visit made by another enforcement/and or advocate agency, conducted on 07/09/25, observed that the facility has two small refrigerators. Both food storage in these refrigerators had unlabeled food items. Also observed were vegetables stored in a cabinet, alongside hand sanitizers. These vegetables were not properly sealed to prevent contamination. Pictures were included to this complaint to reveal what was observed on that date. Based on a review of the report and pictures submitted by this agency, the allegation of staff not ensuring that food items were labeled is Substantiated. Citation issued on the 9099D. Facility is in disrepair: In regards to the allegation, it was reported that the facility air conditioning unit is not functioning. On 07/09/25, a visit to the facility that was made by another enforcement/and or advocate agency. On that day, it was observed that temperature inside the facility was warming. The visiting agency tried to adjust the air conditioning unit, but facility did not cool. Based on what was observed by this credible source, the allegation of facility being in disrepair is Substantiated. Citation issued on the 9099D. Staff did not ensure that records were kept confidential: In regards to the allegation, it was reported that on 07/09/25, a visit to the facility was made by another enforcement/and or advocate agency. It was observed by that agency that resident records, that is kept in a cabinet in the dining area, was unlocked and accessible. The reporting agency submitted pictures of the cabinet, of what was observed that day, and although the cabinet was observed locked during today's investigation, based on the observation of a credible source, the allegation of staff not ensuring records are being kept confidential is Substantiated. Citation issued on the 9099D.the state’s words, verbatim · CDSS document, Sep 24, 2025 · control 31-AS-20250919120442

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Sep 24, 2025

Storage Space and Access: licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage. This requirement was not met as evidenced by a report received from another enforcement/advocate agency's observation of toxins, cleaning supplies and sharps accessible on 07/09/25. This posed an immediate health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: As POC, the licensee will hold staff training to address this section of the regulation. As proof training was held, the licensee will submit a training log, which includes the training topic, date training was held, attendance sheet of staff who attended training, Log is due to the licensing agency by 10/08/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(28) · Plan of correction due date: Sep 24, 2025

General Food Service Requirements: All food shall be protected against contamination. This requirement was not met as evidenced by a report received from another enforcement/advocate agency's observation of the facility food supply not properly sealed and labled, and vegetables stored in a cabinet, alongside hand santizers. This posed an immediate health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: As POC, the licensee will hold staff training to address this section of the regulation. As proof training was held, the licensee will submit a training log, which includes the training topic, date training was held, attendance sheet of staff who attended training, Log is due to the licensing agency by 10/08/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Sep 24, 2025

Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: On 07/09/25, the facility air conditioning was observed to be malfunctioning. This pose a potiential health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: During today's complaint visit, LPAs Panushina and Cava observed the air conditioning unit to be working. No POC needed at this time.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87506(c)(1) · Plan of correction due date: Sep 24, 2025

Resident Records: The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. This requirement was not met as evidenced by: On 07/09/25, resident records was observed stored unlocked and inaccessible in a filing cabinet located in the dining room. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: During today's complaint visit, LPAs Panushkina and Cava observed the filing cabinet, which stores resident records, to be locked. No PCC needed at this time.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87645(h)(2) · Plan of correction due date: Sep 24, 2025

Incidental Medical and Dental Care: Centrally stored medicines shall be kept in a safe and locked place that is not accessible. This requirement was not met as evidenced by: On 07/09/25, medications were observed unsecured in the refrigerator. This posed an immediate health & safety risk to residents.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: As POC, the licensee will hold staff training to address this section of the regulation. As proof training was held, the licensee will submit a training log, which includes the training topic, date training was held, attendance sheet of staff who attended training, Log is due by 10/08/25.

Allegation investigated: Staff are not meeting resident's hygiene needs Staff are not meeting residents laundry needs Facility is in financial distress

Licensing Program Analysts (LPAs) Angela Panushkina and Michael Cava conducted a subsequent complaint visit to this facility to investigate the above allegations. In conjunction to this complaint, complaint investigation (control # 31-AS-20250919120442) and a Required Annual Inspection was also made. LPAs met with staff, Ema Rodriguez, and advised her of the complaint. Today's investigation consisted of a physical plant inspection (conducted between 9:00am-10:00am), interviews with residents and staff (conducted between 10:00am-11:00am), review of medications & medication records (conducted between 11:00am-12:00pm) and interviews with staff and residents (conducted between 12:00pm-1:00pm). Investigation is as follows: Staff are not meeting resident's hygiene needs: In regards to the allegation, it was being reported that Resident 1 (R1) is not being assisted with bathing, shaving, and toileting needs. Interviews with one (1) of one staff deny the allegation. Interviews made with Unsubstantiated five (5) of five residents were unable to confirm the allegation, as information received were inconsistent to the report being made. During today's visit, conducted by LPAs Panushkina and Cava, and the initial visit, conducted by LPA Cava on 09/17/25, R1 was observed to be groomed and had received their hygiene care. Based on the information obtained, it could not be proven that staff are not meeting the resident's hygiene needs. Therefore, the allegation is deemed Unsubstantiated at this time. Staff are not meeting residents laundry needs/Facility is in financial distress: In regards to the allegations, it's being reported that the resident's clothes are not being washed and there were three baskets of dirty clothes unattended to. It's also reported that due to financial distress, the licensee won’t buy detergent so that staff can do the laundry. In addition to not buying the laundry detergent, the licensee is not paying staff their wage. Interview with one (1) of one staff regarding their pay could not confirm the allegation, but note this staff was just hired. Interview with one (1) of one staff also deny not meeting the residents laundry needs. Interviews with five (5) of five residents could not confirm the allegation of staff not being able to meet their laundry needs. Several residents indicate their laundry getting done. During today's complaint visit, made on 09/24/25, LPAs did not observe any baskets of dirty clothes not being washed or attended to. Moreover, laundry was observed getting done on this date. Based on the information obtained, it could not be proven that staff are not meeting the resident's laundry needs, or if the facility is in financial distress. Therefore, these allegations are deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Sep 24, 2025 · control 31-AS-20250916083845

Type of visit: POC

In conjunction to complaint control #31-AS-20250916083845 and an Annual Required visit, Licensing Program Analysts (LPAs) Angela Panushkina and Michael Cava conducted a Case Management visit to the facility to follow up on a Plan of Correction (POC) that was issued on 09/17/25, for the above complaint control number. On that date, due to an inadequate food supply, the licensee was issued a citation for section 87555(b)(26), General Food Services Requirements. Licensee was given until 09/23/25, to clear this deficiency. Today's visit was to insure deficiency is corrected. Based on LPAs inspection of the facility food service on this date, correction is not met. Licensee will be assessed an immediate civil penalty of $700, backdated from 09/18/25 to 09/24/25, for failure to correct this citation, see LIC 421FC, dated 09/24/25. The licensee will be issued another citation for section 87555(b)(26) with an immediate civil penalty of $250 for repeat violation. See 809D. Staff, Emma Rodrguez is advised and a copy of this report issued.the state’s words, verbatim · CDSS document, Sep 24, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Sep 24, 2025

General Food Service Requirements: Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: During a plant inspection of the facility food supply, LPAs Panushkina and Cava did not observe an adequate amount of perishable and non-perishable food. This poses a potential health and safety risk for the residents in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: As POC, the licensee will purchase an adeuquate supply of perishable food items to comply with this section of the regulation. As proof corrections have ben met, licensee will submit a photo copy or receipt that they have purchased an adequate supply of perishable food items. Correction due to CCL no later than 10/01/25.

Type of visit: Required - 1 Year

At 09:30am Licensing Program Analysts (LPAs), Angela Panushkina and Michael Cava, conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20250916083845 and #31-AS-20250919120442. LPAs were greeted by the staff, Emma Rodriguez, who granted access to the facility. LPAs attempted to contact the Administrator, but no one answered. LPAs were informed that the facility has five (5) non-ambulatory, four (4) of which are currently receiving hospice (R1, R3, R4 and R5) and one (1) resident is receiving Home Health. Fire Clearance was approved for six (6) Ambulatory ONLY residents. At approximately 9:35am LPAs conducted a tour of the facility, and the following were observed: Kitchen: LPAs observed insufficient supplies of staple non-perishable for 1 week and perishable for 2 days. LPAs observed Clorox along with other chemicals and detergents under the kitchen sink were kept unlocked and accessible to residents. There is a fire extinguisher by the kitchen and LPAs observed the arrow on a meter was still on a green area, indicating that it was fully charged. Smoke alarm is operational however the carbon monoxide detector is inoperable. Bedrooms: There are three (3) bedrooms designated for residents’ use and have sufficient lighting. All bedrooms have appropriate bedding and linens. Between 9:45am and 9:55am, LPAs observed walls to be poorly scraped up in all three (3) bedrooms. LPAs also observed R1, R2, R3, and R5 had full bed rails, and R4 had ½ bedrail. Physician's order for half/full bed rails were not available upon request. Continue on LIC809-C Bathrooms: At 10:00am LPAs observed two (2) bathrooms are clean, however, one (1) out of two (2) toilet bowl seats was damaged/broken. Both bathrooms were properly supplied with toilet paper, soap, and paper towels. Medications review: At approximately 10:05am team conducted a review of medication for residents in care. LPAs were unable to review centrally stored medication and destruction records. No First Aid Kit and a manual were available for review. Common Areas: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean. However, the living room lacked adequate seating, which include couches, armchairs, etc. LPAs observed only one loveseat available for residents use. LPAs also observed loveseat and dining chairs to be in poor condition (wear and tear). No obstructions observed throughout the facility. The facility license along with personal rights were posted and available for review. Smoke alarm and carbon monoxide detector were checked and observed to be operational. Outside areas: At approximately 10:15am LPAs toured the outside area of the facility. LPAs did not observe backyard furniture to accommodate the six (6) residents. There are no body of water. Laundry: Laundry room is located by the kitchen, and during the walk through, LPAs observed cleaning supplies were not locked. Resident Files: At 10:00am, during the walk through, LPAs requested resident and staff file. S1 contacted an individual named Elsa and was informed that only the Administrator has access to all facility files (staff/residents). Hospice and Home Health files were also not available for review. Staff Files: The following was observed. There is one (1) staff working for at least a month without fingerprint clearance and or association to the facility. At 10:48am, LPA contacted Elsa and was informed that the Administrator is unable to come to the facility today and there is no designee that can provide access to resident/staff files. No files were available for LPAs review upon request. Administrative: Last notice for the annual fee was mailed on 07/02/2025 for the amount of $495.00, which is due by 10/21/2025. The Administrator is also required to submit liability insurance. Deficiencies and civil penalty issued, see LIC809Ds. Exit interview conducted, appeal rights explained and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Sep 24, 2025

Allegation investigated: Staff are not providing adequate food service to residents

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to investigate the above allegation. LPA met with staff, Hilma Torres, and advised her of the complaint. It's being reported that the facility food service only consists of serving cold cuts, hot links, hot dogs, and other assorted frozen meats. There is no variety of fresh food being provided to the residents in care. Today's investigation consisted of a physical plant inspection/inspection of food supply, conducted between 11:50am to 12:30pm. LPA interviewed Staff 1 (S1) between 12:30pm and 1:00pm. Interviews with five (5) of five residents between 1:00pm to 2:00pm. Interviews with the residents were inconsistent with the allegation, but per inspection of the facility food service, LPA observed a lack of fresh/perishable foods items that should be adequate for two (2) days. Based on this observation, the above allegation is Substantiated. Substantiatedthe state’s words, verbatim · CDSS document, Sep 17, 2025 · control 31-AS-20250916083845

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Sep 23, 2025

General Food Service Requirements: Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: During a plant inspection of the facility food supply, LPA did not observe an adequate amount of perishable foods, good for two days. This poses a potential health and safety risk for the residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2025

Plan of correction: As POC, the licensee will purchase an adeuquate supply of perishable food items to comply with this section of the regulation. As proof corrections have ben met, licensee will submit a photo copy or receipt that they have purchased an adequate supply of perishable food items. Correction due to CCL no later than 09/23/25.

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.

Allegation investigated: Staff abandoned resident at the hospital

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. It was reported that the Licensee refused to admit Resident 1 (R1) back to facility after discharge from the emergency department. Mulitiple attempts were made to the licensee to have them take back R1, but the licensee did not reply. R1 remained abandoned at the emergency department until arrangements were made for another placement. LPA met with the administrator, Lala Soghomonyan, and staff, Richie Zhuman, and advised them of the complaint. Today's investigation consisted of interviews with the administrator, staff and residents. LPA also conducted a physical plant inspection and record review of the facility roster. Interviews with both the administrator and staff deny the allegation, stating R1 came for a day, but left voluntarily. R1 never returned to the facility since leaving. When asked if R1 was forced out or denied Unsubstantiated entry to come back, both staff and the administrator stated no, and repeated R1 checked out of the facility voluntarily after a day. In addition to interviewing the administrator and staff, interviews with five (5) of five residents made. These residents stated they do not know who R1 is. A review of the facility roster reveal no entry under R1's name. Based on the information obtained, there wasn't enough evidence to prove that the licensee abandoned R1 at the hospital. Therefore, the allegation is deemed Unsubstantiated at this time. Administrator advised and a copy of this report issued.the state’s words, verbatim · CDSS document, Aug 14, 2025 · control 31-AS-20250813145444

Allegation investigated: Staff did not reposition resident as needed causing resident’s pressure wounds to worsen Staff spoke inappropriately to resident

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. LPA met with staff Arnold Ritchie, and advised him of the complaint. The administrator, Eva Vardanyan, was advised over the telephone. Today’s investigation consisted of interviews with the administrator, staff and residents. LPA also conducted a physical plant inspection of the facility to insure compliance with regulations, and a record review. Staff did not reposition resident as needed causing resident’s pressure injuries to worsen: In regards to the allegation, it was reported that Resident 1 (R1) developed a bedsore to the back due to staff neglect in not repositioning or encouraging the resident to get up from bed. Interview made with the administrator, Eva Vardanyan deny R1 of having wounds. Interview also reveal that on or around 04/10/25, R1’s family was just at the facility and expressed some concerns about R1’s health, and possibly having a wound. As a precaution, R1 was sent to the hospital for a wound check. There were no wounds diagnosed Unsubstantiated at R1’s admission, and R1 was discharged same day with only instructions on how to prevent wounds. On 04/17/25, LPA called and interviewed hospital staff, who confirmed R1’s hospitalization on 04/10/25. Hospital staff stated R1 was admitted and assessed. No wounds noted. R1 was discharged same day. On 04/17/25, call from R1’s family to confirm R1 had not wounds assessed during hospital visit on 04/10/25. R1 was discharged back to the facility with no new orders. In addition to interviews, review of R1's record do not indicate any wounds or skin breakdown. Copy of instructions from the hospital given to R1 at discharge, on how to prevent wounds was obtained. No new orders given. Based on the information obtained, there isn't enough evidence to corroborate the allegation of staff not repositioning R1 as needed causing pressure wounds to worsen. Therefore, the allegation is deemed Unsubstantiated at this time. Staff spoke inappropriately to resident: In regards to the allegation, it was reported that staff have been mistreating R1 and speaking to R1 inappropriately. The complaint report that is received indicated that staff would "treat the resident like a dog" and command him to "Eat!" There were no witnesses identified to confirm this allegation. Interviews with the administrator and staff deny the allegation. The administrator added that it could have just been a language barrier as some of the facility staff are of different nationality. Staff could have just been encouraging the resident to eat and no insults were intended. Interviews with five (5) out of five residents also deny the allegation of staff mistreating them or being inappropriate towards them. Based on the information obtained, there wasn't enough evidence to corroborate the allegation of staff speaking inappropriately to resident(s). Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 31-AS-20250410120520

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Cava conducted a Case Management (CM) visit to the facility to follow up on deficiencies pertaining to complaint control #31-AS-20250423110515. LPA met with staff, Arnold Makura, and advised him of the visit. The administrator, Lala Soghomonyan was advised over the telephone. On 05/01/25, a complaint visit was made, and the facility was issued citations for sections 87202(a)(1)- Fire Clearance and 87608 (5)(B)- Postural Support, with a plan of correction date due 05/08/25. Today's visit was to insure corrections have been made. Regarding 87202 (a)(1)- Fire Clearance, licensee is in the process of submitting the request to obtain the fire-clearance to retain non-ambulatory clients. POC still due by end of close of business (COB) Regarding 87608 (5)(B)- Postural Support, licensee replaced the bedrails for Resident 4 (R4) to comply with 87608(5). "A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed". Citation will be cleared. In addition to following up with the citations, LPA made a physical plant inspection to insure the health and safety of the residents in care. No immediate health and safety concerns noticed at this time. LPA did observe two hospice nurse at the facility at the time of the visit. Exit interview conducted and a copy of this report issued.the state’s words, verbatim · CDSS document, May 8, 2025

Allegation investigated: Facility retains non-ambulatory residents without approved fire clearance.

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with staff, Arnold Makura, and advised him of the complaint. It was reported that the facility is licensed for six (6) clients and according to the license the clients should be ambulatory or on hospice but the clients currently in care may not meet those criteria. Today's investigation consisted of interviews with staff and residents, a physical plant inspection and record review. Facility currently has a census of four (4) residents. In addition to interviews with the residents, LPA requested for all four residents to demonstrate whether or not they can get up and go to the bathroom, or exit their rooms on their own. Per resident interview and resident demonstration, LPA was able to identify three (3) of the four residents to be non-ambulatory through interviews and their inability to get up and ambulate on their own. In addition, another Resident, (R6) refer to LIC 811, who just moved out, was also identified as non-ambulatory. Based on the information obtained the above allegation is Substantiated. Citation(s) issued on the 9099D. An immediate Civil Penalty (CP) of $500 for fire clearance issued. Licensee advised that CP of $100 will continue to accrue daily, until this deficiency is corrected. Copy of this report issued. Substantiatedthe state’s words, verbatim · CDSS document, May 1, 2025 · control 31-AS-20250423110515

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(1) · Plan of correction due date: May 1, 2025

Fire Clearance: All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining (1)Nonambulatory Persons, licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: LPA identified four residents that were non-ambulatory.the state’s words, verbatim · CDSS document, May 1, 2025

Plan of correction: As POC, the licensee will apply for the appropriate fire-clearnace to retain nonambulatory residents. If the fire clearance cannot be approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal, the licensee will need to relocate the residents identified as non-ambulatory by May 8, 2025. An immediate Civil Penalty (CP) was assessed for $500 today for fire clearance violation. This CP will continue to accrue at $100/day if the licensee fails to correct this deficiency.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(5)(B) · Plan of correction due date: May 1, 2025

Postural Support: Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirment was not met as evidenced by: during investigation, LPA observed R4 to have bedrails that extended beyond half the length of the resident's bed. R4 did not have a hospice care plan on file that specifies the need for full bed rails.the state’s words, verbatim · CDSS document, May 1, 2025

Plan of correction: As POC, licensee will remove or replace the bedrails to comply with 87608(5). A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. If R4 is receiving hospice care, licensee will produce a hospice care plan to specify the need for the full bed rails. As proof this is corrected, POC due to the licensing agency by May 8, 2025.

Allegation investigated: Staff is unable to communicate with resident due to language barrier Staff do not dispense medication to resident as prescribed

In conjunction to complaint control # 31-AS-20250410120520, Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. The initial visit to the complaint was made on 03/27/25. LPA met with then, Staff 1 (S1), who was advised of the allegations at that time. Today, LPA met with Staff 2 (S2), Arnold Makura, and advised him of the complaint. Administrators Lala Soghomonyan and Eva Vardanyan were both advised over the telephone. Today’s investigation consisted of interviews with administrator, staff and residents. LPA also conducted a physical plant inspection and record review to insure facility compliance with Title 22. Staff is unable to communicate with resident due to language barrier: In regards to the allegation, it was reported that there is a caregiver, (S1) who does not speak English, and must contact the owner to assist with communication. LPA conducted interviews with S1 during the inital visit to this complaint, and although S1 is of a different nationality, LPA was still able to communicate with Unsubstantiated S1. There were some occasions when S1 had to refer to google translate on the cellphone, but nonetheless, LPA was still able to communicate with S1. Interviews with six (6) of six residents also do not corroborate with the allegation. These residents stated they have no issues with communication with S1 or S2. Both staff are able to meet their needs. Based on the information obtained, there wasn’t enough evidence to prove that S1 is unable to communicate with residents due to a language barrier. Therefore, the allegation is deemed Unsubstantiated at this time. Staff do not dispense medication to resident as prescribed: In regards to the allegation, it was reported that there is some belief and concern that Resident 1 (R1) may not be given medication as prescribed. Information obtained could not identify which medications R1 was not receiving as prescribed. Interviews with the administrator and staff deny the allegation. Interviews with six (6) of six residents also deny the allegation. Residents interviewed expressed no concerns of staff’s medication management, stating they get medications as prescribed. These residents also had no complaints regarding the care and supervision provided by staff. In addition to interviews, LPA conducted a record review of R1's medication. No discrepancies were observed regarding R1’s medication. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not dispensing R1’s medication as prescribed. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Apr 17, 2025 · control 31-AS-20250324145609

Allegation investigated: Staff neglect resulted in a resident to be hospitalized Staff did not keep the facility free from bed bugs

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with staff, Eva Martirosyan, and advised her of the complaint. The administrator, Lala Soghomonyan, was notified and interviewed over the telephone. Today's investigation consisted of interviews with the administrator, staff and residents. LPA also conducted a physical plant inspection. Staff neglect resulted in a resident to be hospitalized: In regards to the allegation, it was reported that Resident 1 (R1) was admitted to the hospital on or around March 3, 2025 for pneumonia and bed sores. Reporting Party (RP) could not confirm the stage of the bed sore, but stated most likely it wasn't greater than a stage II. Interview with the administrator deny the allegation. Administrator stated R1 only stayed at the facility overnight. R1 was admitted the evening of March 2, 2025, and was taken out by family the morning of March 3, 2025. According to the Unsubstantiated administrator, R1's family wanted to move R1 to another facility. Also, according to the administrator, at admission, R1 had no wounds. As for pneumonia, although R1 may have a cough, R1 made no complaints of heavy coughing, fever or having trouble breathing. If that were the case, administrator and staff would have pursued immediate medical attention. Moreover, because R1 was at the facility for less than twenty four hours, administrator was unable to have R1's licensing forms completed. R1's family moved R1 out of the facility abruptly. Based on the information obtained, it could not be proven that staff neglect resulted in R1 to be hospitalized. Therefore, the allegation is deemed Unsubstantiated at this time. Staff did not keep the facility free from bed bugs: In regards to the allegation, it was reported that at admission to the hospital, R1 had bed bugs. Interviews with administrator and staff reveal that R1 was only in the facility overnight, and not more than twenty four hours. R1 was admitted into facility the evening of March 2, 2025, and left with family the morning of March 3, 2025. According to the administrator, R1's family wanted to move R1 to another facility. According to both staff and residents, facility does not have any bed bugs. Interview with five (5) of five residents deny facility having any bed bugs, or any other issues with insects. LPA conducted a tour of the physical plant, which includes inspecting three (3) bedrooms, two (2) bathrooms, and common areas. LPA did not observe any insects/bed bugs during the day of the investigation. Based on the information obtained, it could not be proven that staff did not keep the facility free from bed bugs. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Mar 6, 2025 · control 31-AS-20250303224232

Allegation investigated: Facility staff slapped a resident Facility staff kicked a resident

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to conclude the investigation regarding the above allegation. The initial ten day visit was made by LPA Cava on 11/14/24. During the course of the investigation, interviews with resident, staff and resident family were made. LPA also conducted a physical plant inspection and record review. Facility staff slapped a resident/Facility staff kicked a resident: Regarding the above allegations, it was reported that on or around 11/09/24, Resident 1 (R1) was slapped and kicked by a staff. On 11/19/24, another report received from another agency allegging that Resident 2 (R2) was also slapped by staff from this facility. Staff 1 (S1) was identified, but when interviewed, S1 denied the allegation. No other witnesses were identified. During the initial visit that was made on 11/14/24, LPA interviewed S1, who denied both allegations, stating Unsubstantiated R1 is very aggressive and combative towards staff. LPA was unable to interview R1 during initial visit because R1 was taken to the hospital for evaluation. Return date was unknown at that time. LPA interviewed R2 during the initial visit, and R2 was unable to confirm if staff was aggressive towards R1. Moreover, R2 denied S1 ever being aggressive towards residents during the day of that interview. Also during the initial investigation, LPA Cava made contact with R1's family, who cannot confirm if S1 had been aggressive towards R1. R1's family further stated R1 has a diagnosis that limits the ability to communicate and store memory. LPA did attempt to interview R1 over the telephone, but was not getting a response. Today's investigation consisted of interviews with the administrator, Lala Soghomonyan, and staff Eva Vardanyan and Eva Matirosyan, who deny both allegations. Administrator adds that R1 had been aggressive towards staff since moving into facility. R1 did not stay too long in the facility. After being taken to the hospital for evaluation, R1 never returned. Interviews with five (5) of five residents could not corroborate with the allegations. These residents moved in after this complaint was made. When residents were asked if current staff have been aggressive towards them, all residents stated no. Based on the information obtained, there wasn't enough evidence to probe that Facility staff slapped and kicked a resident. Therefore, the allegation is deemed Unsubstantiated at this time. Administrator advised, and a copy of this report issued.the state’s words, verbatim · CDSS document, Feb 28, 2025 · control 31-AS-20241113152157

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representative/administrator, Lala Soghomonyan and their consultant, Yeva Vardian. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on February 20, 2024. A fire clearance was approved on August 12, 2024 for six (6) ambulatory only residents, for a total capacity of six. The applicant has requested a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual and inter-connected. The facility has a new fire extinguishers that was purchased on August 6, 2024. It is located by the kitchen. A tour of the physical plant was initiated at approximately 10:00am, after the Component III presentation. The following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. No residents in the home at this time, therefore, perishable food items is not required during the inspection. Applicant was advised that they would need to purchase perishable food items, once they admit their first resident. There was an adequate supply of non-perishable food items. Knives will be kept locked in a kitchen drawer. Cleaning supplies will be kept locked in a cabinet under the sink. Medications will be kept locked in another cabinet located in the kitchen. BEDROOMS: There are three (3) bedrooms designated for client use. All bedrooms will be shared rooms. Bedroom #1 has it's own bathroom. The applicant furnished the resident bedrooms with two beds, two night stands, two chairs, a dresser large enough for two residents in the room to share, bedding and linen. The bedrooms have sufficient lighting and closet space. Additional linens and towels maintained in closet in the hallway. BATHROOMS: The facility has two (2) bathrooms. Bedroom #1 has it's own bathroom with shower and tub. The other bathroom is located in the hallway. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 117 and 118 degrees. COMMON AREAS: These included the living room and dining room. The living room has two couches, a coffee table and television. There is a fireplace, that is screened, but non-functional. No fireplace tools were present. The dining room is located by the entrance. Dining room table is large enough to seat up to six (6) residents. There is an additional refrigerator located near the dining room area. LAUNDRY ROOM: The laundry room is located by the kitchen. No detergents or cleaning supplies will be kept in this area. MEDICATIONS: Medications will be kept locked in a kitchen cabinet. STAFF/RESIDENT RECORDS: There are two filing cabinets located by the dining room where staff and resident records will be maintained and locked. GARAGE: The garage is attached to the building, but no access from the inside of the home. Only access is outside of the facility, but it is kept locked at all times. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. The backyard of the facility has a patio area with chairs/seating area for the residents to use. The facility's backyard has sufficient yard space to hold outdoor activities. There are no swimming pools or any other bodies of water. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held prior to the physical plant inspection. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment is observed to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 10, 2024

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Name - Sargis Umrikyan CEO/ Lala Soghomonyan Administrator Interview Method: Telephone interview On September 20, 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 the 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, Sep 20, 2024