Ayla House for Elderly Care

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Nadia Shahbazian arrived at the facility to conduct a case management visit to confirm if the facility is currently in operation or closed. LPA met with Administrator, Heghine Avetisyan-Administrator and explained the purpose of the visit. Community Care Licensing Division (CCLD) was notified of the intent to close this facility, but no specific date of closure was given. Administrator informed LPA that the house is rented and the lease will not be renewed. The Licensee is no longer interested in keeping the facility open and wishes to cease operation due to personal reasons. All residents were provided facility closure letters and all residents have all been relocated. A tour of the physical plant was conducted with Administrator at 10:15am, including the house, the surrounding and the garage. Facility is currently not occupied by residents. Facility has been absent of residents since last resident was relocated on 06/25/26. LPA confirmed that there are no residents in the facility. LPA collected the original license during the visit. LPA confirmed mailing address. Community Care Licensing will be mailing an official closure letter. LPA reminded the Administrator that if they should decide to reopen, a new application with all the appropriate documents and fees shall be submitted to CCLD. LPA informed Administrator that a license will need to be approved before operation and no unlicensed care shill be provided.. Exit interview conducted. A copy of this report provided to Licensee.the state’s words, verbatim · CDSS document, Jul 21, 2026

Type of visit: Case Management - Other

On 06/09/2026 Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced case management visit in the facility. Upon arrival LPA met with Staff-Yelena Grigoryan and explained the reason for the visit. LPA contacted the Administrator Ms. Heghine Avetisyan over the telephone but was unable to speak with her. Upon arrival LPA observed three (3) residents having breakfast in the dining room. At approximately 9:20am facility Consultant-Ms. Hripsime Tavitian arrived and informed LPA that the licensee is considering closure of the facility as of 06/30/2026 since current administrator is unable to oversee the facility on regular basis. At around 10:15 AM, with assistance of the Consultant, LPA conducted a physical plant tour to ensure health and safety of the residents; no immediate issues were observed. Facility was observed to be clean and fully furnished and with plenty of food supplies in the refrigerator and cabinets. Current census is five (5) residents but one (1) is currently in hospital. LPA interviewed four (4) residents and all residents stated they are happy in the facility. LPA reviewed the records for all five (5) residents. Consultant notified LPA that facility lease is about to expire but she was unsure of the exact date. Consultant also stated that Licensee wants to close the facility as of 06/30/2026 due to facility lease expiration and Administrator's irregular schedule. LPA advised Consultant that facility can not be closed by 06/30/2026. Licensee needs to provide 60 day notice to all the residents, their responsible parties and to California Department of Social Services (CDSS) regarding the closure. The 60 day notice needs to include closure date with available resources to assist residents with alternative housing and care options, including public and private referral services and case management organizations. LPA advised that residents can not be evicted without notification to CDSS. No deficiencies cited during today's visit. Copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 9, 2026

Type of visit: Required - 1 Year

On 01/23/2026 Licensing Program Analyst (LPA) Nadia Shahbazian conducted an Annual Required visit and inspection of the facility. Upon arrival LPA met with Staff-Yelena Grigoryan and explained the reason for the visit. The Residential Care Facility for the Elderly (RCFE) is licensed to serve residents ages 60 and above. Facility is approved to serve (6) Ambulatory residents, with hospice waiver for (6). At 10:40AM, LPA spoke with Administrator - Ms. Heghine Avetisyan over the telephone. Administrator stated that she can not come to the facility today but designated Staff Yelena Grigoryan to sign the report. At 11:45am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the living room. Facility has multiple exit doors but uses the entry door and the exit door in the family room, as the main exits. There are clearly marked exits sign above all exit doors. The smoke and carbon monoxide detectors are hardwired and interconnected. At 11:48am smoke/carbon monoxide detectors were tested and observed to function properly. The fire extinguishers are located in the kitchen and in the living room, both fire extinguishers were serviced on 04/28/2025. Kitchen: The kitchen appliances and work surfaces are clean and sanitary. Appliances consisted of a stove, dishwasher, microwave, refrigerator and a small freezer. There is a dining set on one corner of the kitchen. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. LPA observed emergency water supplies in the kitchen as well. Knives and sharp objects were stored in a locked drawer in the kitchen and chemicals were observed to be locked, underneath the sink. Continued on 809-C Common Areas: The living room and dining room are located by the entry door. There is a dining area in kitchen and a family room by the kitchen. Family room has an exit door leading to the backyard. The common areas were properly furnished with ample seating for all residents and staff. In addition, LPA observed a small refrigerator in the dining room. There are games, television, cable and internet access for clients' use. Bedrooms: There were three (3) shared bedrooms designated for residents' use. All of the bedrooms were were properly furnished with appropriate beds, chairs, closets and linens with sufficient lighting. Bedrooms #1 and #2 have exit doors, leading to the backyard. Bedroom # 2 has it's own private bathroom. Bathrooms: There are two (2) full bathrooms designated for residents' use. Both bathrooms had required functional fixtures, grab bars and non-kid mats. Hot water temperature was measured between 112.8 and 115.0 degrees Fahrenheit. Surrounding Grounds: There are no bodies of water present. Facility has multiple exit doors but uses the main entry and the exit door in the family room, as the main exits. All walkways and exit passages were free of obstruction. There is a covered patio with two sets of furniture, appropriate for outdoor use. There is a detached garage, which was converted to a staff room. Laundry Area: Washer and dryer are located inside the main bathroom. Chemicals, detergents and the laundry machines are separated by a locked door and are kept inaccessible to residents. Medications/Resident Files: All resident records and medications are kept locked in a kitchen cabinet. Medications for all 4 residents were counted and records were reviewed for accuracy of administration, based on physician orders. LPA conducted a file review of all 4 resident records to ensure compliance of licensing forms and current physician records. Staff Files: LPA conducted a file review of staff records to ensure forms and training are up to date and compliant with licensing forms. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted / A Copy of the Report Issued to the Staff.the state’s words, verbatim · CDSS document, Jan 23, 2026

Allegation investigated: Unlicensed care is being provided.

Licensing Program Analyst (LPA) Abeye Duguma conducted a subsequent complaint visit for the above allegation. At approximately 10:00 AM, LPA met with caregiver, Yelena Grigoryan, explained the reason for the visit and was granted access to the home to conduct an inspection. During the inspection, LPA observed four (04) residents in the facility and one (01) staff. Resident #1 (R1) that required a higher level of care and supervision is no longer in the home. At around 10:15 AM, LPA conducted a physical plant tour to ensure health and safety. Although the operator relocated R1, the allegation will remain SUBSTANTIATED at this time. A NOTICE OF OPERATION IN VIOLATION OF LAW was served on 12/19/2024 prior to licensure. No additional citations issued at the time. Exit interview conducted and report issued. Substantiatedthe state’s words, verbatim · CDSS document, Apr 9, 2025 · control 31-AS-20241219103942

Type of visit: Prelicensing

On 12/09/24, at 09:25am, Licensing Program Analyst (LPA) Gina Saucedo conducted an announced Pre-licensing visit. LPA's met with Administrator Elena Kordonskiy at 9:25 am. An application was submitted to Community Care Licensing Division-CCLD on 02/29/2024, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for six (6) ambulatory ONLY. Structure: The facility is a single-story building with three (3) bedrooms and two (2) bathrooms. Entrance: There is only one (1) entrance being utilized. Required postings such as: Personal Rights of Residents, Emergency and Disaster Plan, Yes sign, Ombudsman, Resident Infection Control are on your left hand side of the facility. Toxins, cleaning solutions, and laundry detergents are kept locked and inaccessible to residents in a cabinet in the bathroom. Living/Dining area: The living room is neat, clean, and organized with sufficient seating for both residents and staff. The dining area is also neat, clean, and organized. Both rooms are properly furnished and in good repair. The facility maintains a comfortable temperature of seventy-one (71) degrees. No firearms observed or will be maintained on the premises. Resident/staff files: Resident and staff files are currently locked in a cabinet in the kitchen. LIC809C-continued Kitchen: Sufficient supplies of dishes, cups, and silverware located within the kitchen cabinets and drawers. Sharps are stored on the left side of the kitchen locked and inaccessible to the residents. Sufficient supply of food such as: canned goods, bottles of water, cereal were observed in the garage. Kitchen appliances are working and are in good repair. First-aid kit observed as well in the kitchen. There is a working telephone on the premises on the kitchen counter. Emergency: Fire extinguisher located in the kitchen on the left side and dated 12/07/2024. Medications: Medication is stored in the kitchen cabinet on your right hand side. The medication is currently kept in kitchen cabinet locked and inaccessible to the current residents. Bedrooms: The bedrooms are properly furnished with bed, nightstand, applicable lightening, and seating. Window coverings are in good repair, not broken or damaged. All the bedrooms are shared. There are three (3) bedrooms that are currently occupied. Bathroom: The bathrooms are in proper condition and will be equipped with sufficient personal hygiene for each client. Towels and washcloths will not be shared. Hallways: Hallway is properly lighted. Staff room: There is no designated staff bedroom in the facility. Water Temperature: The water temperature was measured in the bathrooms at 118.8 Fahrenheit and is within regulations. LIC809C-continued Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested. There is no garage but there is an Accessory Dwelling Unit (ADU) in the back of the house detached from the home that will be used for staff living which is not on the facility sketch. The administrator/Licensee is aware that ADU has to be available for LPA observation and everyone living in the ADU has to be fingerprinted and have a background clearance. LPA did have access to the ADU at the time of the tour. Outside: The outside is clean, free of hazards, and will be properly furnished with sufficient seating. A shaded area for residents was observed as well. Pool: no bodies of water located at the facility. Administration: The facility had submitted an Emergency and Disaster Plan For Residential Care Facilities For The Elderly and Infection plan. The Component III Orientation RCFE was shown/reviewed with the Administrator. At this time, the facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Be advised, this was a unlicensed facility and they have now applied for a license. There is currently four (4) residents that ambulatory. The Administrator Elena Kordonskiy is currently the staff. Exit interview conducted and copy of this report issued to the administrator.the state’s words, verbatim · CDSS document, Dec 9, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Avetisyan, Armen & Kordonskiy, Elena On 11/14/24, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 14, 2024