Assisted Living on Glade

Allegation investigated: Facility staff refuse visitor(s)

At 09:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted an conducted a subsequent visit to deliver the final finding. LPA met with the Designee, Nina Blayan, and explained the reason for the visit. During the initial visit conducted on 12/27/24, course of the investigation, interviews and record review were made. At 11:45am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Visitors Sign in Sheet, etc., relevant to the investigation. At approximately 11:50am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 12:00pm – 12:30pm, LPA conducted an interview with the Designee, two (2) staff, and two (2) out of four (4) residents, who were able to communicate. LPA also conducted an interview with R1's Conservator. Continue on LIC9099-C Unsubstantiated Allegation: Facility staff refuse visitor(s) It was alleged that R1's son was not allowed to visit R1. To investigate this allegation, LPA conducted interviews with the Designee and two (2) staff members. The interview with the Designee revealed that in December 2024 due to the peak of influenza season, as a precaution the facility notified family members to limit visitations. Two staff members interviewed corroborated with the statement provided by the Designee. Additionally, two (2) out of four (4) residents interviewed expressed no concern regarding this allegation and informed LPA that visitation has never been an issue at this facility. Interview with the Conservator revealed that he/she was well aware of the situation (changes, visiting hours, etc.) and also expressed no concerns regarding this allegation. Lastly, review of the facility "Visiting Sing In Sheet" revealed that from 12/01/2024 to 12/27/2024 all residents had visitors. LPA also observed that R1's son visited R1 every day or every other day. Based on interviews and file/document reviews this allegation is deemed Unsubstantiated at this time. Exit interview conducted appeal rights explained and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jul 17, 2025 · control 31-AS-20241220164846

Type of visit: Required - 1 Year

At 9:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual inspection. Upon arrival, LPA met with Staff #1, who granted access to the facility. The Designee, Nina Blayan, arrived shortly after and LPA explained the reason for the visit. At 9:40am LPA conducted a tour of the physical plant and observed the following: The facility is licensed for capacity of six (6) residents. The fire clearance is approved for five (5) Non-Ambulatory in rooms #1, #2, #3 and #4, of which one (1) may be Bedridden In room #5. The facility also has approved hospice waivers for six (6) residents. Bedrooms are appropriately furnished and have appropriate lighting. LPA observed Resident #4 in bedroom #3. Based on a fire clearance approval and review of R4’s Physician’s Report, R4 must reside in bedroom #5. The facility has awake staff. Bathrooms have soap and paper towels. Extra towels and linens were readily available. The hot water temperature measured at 116.1°F. Facility maintains a temperature of 77°F. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. The fire extinguisher is located in the kitchen and was last purchased on 05/14/2024. The laundry is located in the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. All chemicals and detergents are kept in the garage and inaccessible to residents in care. LPA observed all medications locked in the hallway closet. Smoke detectors and carbon monoxide monitors were tested at 10:50am and observed to be functional. At 11:00am, LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Continue on LIC809-C LPA discussed the importance of maintaining care and supervision to meet the needs of residents. Between 11:30am to 12:30pm, LPA reviewed records of five (5) residents and four (4) staff. Resident and staff records appeared to be complete and updated. The annual fee is paid in full. LPA observed Administrator certificate last renewed on 01/22/2025 with an expiration date of 01/21/2027. LPA collected the Certificate of Liability Insurance and LIC500. Citation issued on LIC809-D during this visit. Exit interview conducted and a copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jul 17, 2025

Type of visit: Prelicensing

At 9:30am Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-Licensing Inspection and met with the facility administrator Sona Gevorkyan and Licensee Sipan Movsesyan. An application was submitted to Community Care Licensing Division-CCLD on 02/20/2024, Initial license for a Residential Care Facility for the Elderly, 60 years and older. A fire clearance was approved on May 21, 2024 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six (6). The bedridden fire clearance is for bedrooms #5. Bedrooms #1, #2, #3, and #4, cleared for non-ambulatory residents. Bedroom #6 is cleared for ambulatory resident only. The Licensee also requested a hospice waiver and granted for six (6) residents. The facility is a single-story home. With the assistance of the Licensee/administrator, a tour of the physical plant was initiated at approximately 10:00am and the following was observed: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven, dish washer and sink. The kitchen appliances and fixtures were functional. LPA found a sufficient amount of non-perishable food at the facility; properly stored. Perishable food items are not required at this time as there are no residents in the facility. LPA observed dining ware to accommodate a maximum capacity of six (6) residents. Knives and sharps will be stored in a locked cabinet inside the kitchen. Kitchen chemicals are stored in the separate locket closet. BEDROOMS: There are six (6) bedrooms designated for residents’ use. All bedrooms are furnished and well equipped with beds, nightstand, chair, dresser, bedding, and extra linen. Rooms were observed to have sufficient lighting and closet space. Auditory alarms were tested and observed to be operational at 10:15am. Facility will have awake staff. Emergency call buttons/bells are available and will be provided to residents. Continue on LIC809C BATHROOMS: The facility has two (2) bathrooms, bathroom #1 is located inside bedroom #1, bathroom #2 is located in the hallway next to the bedrooms #2 and #4, and designated for both residents and staff. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 10:20am to be at 110°F degrees. MEDICATION: LPA observed medication, facility staff/resident files, and First Aid kit will be kept locked in the separate storage room inside the locked cabinet and inaccessible to residents in care. LPA observed First-aid kit is complete and has new manual. Facility has Dementia Care Program. SMOKE DETECTORS/CARBON MONOXIDE. The smoke detectors and carbon monoxide are hard wired, inter-connected and were located throughout the facility. At 11:00am they were tested and observed to be operational. The facility has one (1) new fire extinguishers that was purchased on May 14th, 2024. The fire extinguisher is located in the kitchen. COMMON AREAS: The facility maintains a comfortable temperature at 74°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. LPA observed puzzles, books, balls, and board games to provide activities to residents in care. Living room has fire place, which is blocked with TV stand. Facility has land line, LPA checked its operational. SURROUNDING GROUNDS: In the back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with covered shaded area for residents. The backyard is fenced. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There are no bodies of water. GARAGE: The garage is currently being used for storage. The LPA observed the garage locked and inaccessible to residents in care. In addition, the team observed laundry room is located in the garage. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. Component III was conducted with the Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and will be notified by the CAB Analyst when the license has been approved. Exit interview was conducted and a copy of this report was provided to the Applicant/Administrator.the state’s words, verbatim · CDSS document, Jun 14, 2024