Ludlow Assisted Living Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Grigor Petrosyan, and explained the reason for the visit. The administrator, Tatevik Balasanyan was advised of the visit over the telephone. Administrator was unable to attend the annual on this date. With the assistance of a Staff 1 (S1), LPA took a tour of the physical plant. The facility is a one story building. The smoke alarms and carbon monoxide detectors are dual and interconnected. There is a fire extinguisher located in the kitchen. The charge date is 03/03/2026. The latest earthquake, fire and emergency disaster drill was conducted on 03/25/26. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food properly stored. Knives were stored in a lock box. Bedrooms: There are six (6) bedrooms designated for the residents. All six rooms is for private use. LPA observed the resident rooms to be properly furnished with appropriate beddings and linens with sufficient lighting. Exit doors in resident rooms were clear of obstruction. Auditory alerts in all rooms were tested and are functional during the inspection. Bathrooms: There are four (4) full bathrooms and two (2) half for a total of six (6) bathrooms. All bathrooms designated for resident use are properly supplied and had the proper fixtures, grab bars and non-skid mats. Hot water temperature was measured between 114 to 116 degrees Fahrenheit. Common Areas: These included the living room and dining area. The living room has sufficient seating of couches, recliner, table and television. There is no fireplace. The dining room table is large enough to accommodate six (6) residents. LPA observed the furniture to be maintained and in good repair. Floors were mopped and clean. Hallways were clear of obstruction. The auditory alarms on all exit doors were on and functional at the time of the visit. 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 outdoor furniture to accommodate the six (6) residents. The backyard has sufficient yard space to hold outdoor activities. There is no swimming pool or any other bodies of water. GARAGE: Facility does not have a garage. Laundry: The laundry area is located in the hallway between the kitchen and client rooms. It was observed with a sliding door. Detergents and cleaning supplies are stored in a locked closet, across from the laundry area. Office/Staff Work Station: Staff workstation is located by the living room where resident and staff files are kept in a locked cabinet there. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medications are kept in a locked cabinet, located in the staff office/work station. A complete first aid kit and manual is also kept in the medication cabinet. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Apr 4, 2026

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 Resident 1 (R1). LPA met with the assistant administrator, Grigor Petrosyan, and advised him of the visit. On 10/16/25, the Department received information that the facility admitted Resident 1 (R1), who is temporary bedridden. The facility has a fire clearance for six (6) non-ambulatory only. Today's CM visit consisted of a physical plant inspection and an assessment of R1. The facility is a one story building with six (6) bedrooms. All bedrooms are for private use. Each bedroom has it's own exit, with doorways that measure at approximately 48 inches. Hallways leading to the resident rooms measure between 48-54 inches. There are sprinklers installed all throughout the inside of the physical plant. During an assessment of R1, LPA observed R1 to be able to reposition in bed with some assistance. R1 does require assistance to get out of bed. According to the administrator, R1's status at the facility is temporary only. LPA requested for the licensee to submit the following in order to comply LIC 200 and facility sketch to request for a bedridden fire-clearance. (This is obtained during today's visit) An exception request to retain R1, which will include the following information Exception request letter from facility to Department 2. LIC 602 – Physicians Certification 3. LIC 625 - Appraisal Needs and Services Plan 4. Physician Orders 5. Medical Records (Orders from the Hospital, Discharge Summary, Home Health orders) 6. Facility plan of care for the health condition exception is being requested for…. 7. Staff training component to include topics and materials Exception request due to the Licensing Agency by Monday, October 20, 2025. Assistant Administrator advised and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 17, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representatives Tatevik Balansanyan and Grigor Petrosyan. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on August 20, 2024. The facility is a one story building. A fire clearance was approved on December 5, 2024, for six (6) non-ambulatory residents, for a total capacity of six. All bedrooms have a fire clearance for bedridden. The applicant is also requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual, hard wired and inter-connected. The fire extinguisher is located by the kitchen. It was purchased on 12/05/24. A tour of the physical plant was initiated at approximately 10:00am and the following was observed: KITCHEN: The kitchen area is equipped with a refrigerator, stove/oven, microwave and sink. There is an adequate supply of nonperishable food items. No perishable items at this time as there are zero clients. Applicant was advised to purchase perishable items once facility admits clients. There is sufficient dining ware to accommodate a maximum capacity of six (6). Knives will be kept in a locked box and stored in one of the kitchen cabinets. BEDROOMS: There are six (6) bedrooms designated for client use. All bedrooms are private. Per STD 850, all bedrooms have a bedridden fire clearance. The applicant furnished the resident bedrooms with a bed, night stand, chair, bedding and linen. The bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has six (6) bathrooms. Four (4) full and two (2) are half. Bedooms #1 and #6 has its own full bathroom. The other two full bathrooms are in the hallway. In addition, there are two half bathrooms designated for guest and staff. The bathrooms designated for resident use were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 114 degrees. COMMON AREAS: These included the living room and dining room. The living room is furnished with two couches, two chairs, a center table and television, The dining room table was large enough to sit up to six (6) individuals. There is no fireplace. Front entrance has a table for sign-in. All exit doors in the bedrooms and common areas were checked to insure the door alert is functional. There were no visible immediate hazards. GARAGE: Facility does not have a garage. LAUNDRY AREA: The laundry area is located in the hallway between the kitchen and client rooms. It was observed with a sliding door. Detergents and cleaning supplies are stored in a locked closet, across from the laundry area. MEDICATIONS: The medications will be kept in a locked cabinet, located in the staff office/work station. A complete first aid kit and manual is also kept in the medication cabinet. OFFICE/STAFF WORKSTATION: Staff workstation is located by the living room. Client and personnel files will be maintained in a locked cabinet there. 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 outdoor furniture to accommodate the six (6) residents. The facility backyard has sufficient yard space. There is no swimming pool or any other bodies of water. In addition to the Pre-Licensing inspection, a Component III power point presentation was held. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears 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, Mar 4, 2025

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Tatevik Balasanyan (Board Member/Administrator) Interview Method: Virtual interview via Microsoft Teams On December 19, 2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Dec 19, 2024