Winnetka Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff, Dildan Anarkulova, and explained the reason for the visit. At 9:02 AM administrator, Anna Gasparyan, arrived and was explained the reason of the visit. At 9:38 AM, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 10:01 AM the smoke alarms were tested and are operational. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 9.2.2025. During the visit the facility is at 75 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory of which one (01) may be bedridden in bedroom #3. Hospice waiver for five (5). Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Office space is in the living room. Medications of the residents properly labeled medications were locked in the cabinets in between the dining table and kitchen. R2's Lantus was observe to be kept unlocked in the facility refrigerator, which was observed to be accessible. Deficiency will be cited in LIC 809-D. Bedrooms: There were four (4) bedrooms designated for residents' use. Bedrooms that are in use by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Room #1 and room #2, are properly furnished and are shared. Bedroom #3 and bedroom #4 are private. Bedroom #1 and bedroom #2 currently has only one resident in each bedroom. Continue to LIC 809-C Bathrooms: There are two (2) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 106.8 degrees Fahrenheit for bathroom #1 located inside bedroom #1. Bathroom #2 measured 105.8 degrees Fahrenheit located beside bedroom #3 located in the hallway. Cleaning supplies are being stored in a locked cabinet under the sink. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. Fireplace is close, non-operational and blocked. The auditory alarms on all exit doors were on and functional at the time of the visit. Residents dining table fits enough for six (6). Office is located beside the living room. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located beside the kitchen. The facility does not have a swimming pool or body of water. The garage is detached and is used for storage. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records (MMR) were review for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies were observed during the visit. Exit interview conducted and a copy of the report issued.the state’s words, verbatim · CDSS document, Sep 15, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Sep 16, 2026

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on LPA’s observation, the administaror did not comply with the section cited above. LPA observed R2's medication unlocked and accessible to resident in care in facility refrigerator, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 15, 2026

Plan of correction: Administrator agreed to purchase a lock box for refrigerated medication by POC date.

Type of visit: Prelicensing

On 7/2/25 at 9:30am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a Pre-Licensing Inspection with the facility Administrator Anna Gasparyan. Upon arrival, LPA introduced herself by showing her department badge. This is a single-story house which will be operating as Residential Care Facility for Elderly (RCFE). A fire clearance was approved on April 8th, 2025, for six (6) Non-Ambulatory residents of which one (1) may be Bedridden for bedroom #3. Facility also received Hospice approval for five (5) residents. The smoke alarms and carbon monoxide detectors are hard wired and inter-connected, they were tested and are operational. The facility has one (1) fire extinguisher that was purchased on 3/21/2025 and is located on the kitchen wall. 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, gas stove, microwave oven and sink. LPA observed adequate supplies of emergency and nonperishable food properly stored inside the kitchen cabinets. Perishable food items are not required at this time as there are no residents in the facility. Licensee will supply sufficient amount of perishable food upon arrival of the residents. Complete dining ware was available to accommodate a maximum capacity of six (6) residents. Knives and other sharps were observed locked inside the kitchen cabinet and chemicals observed stored inside locked cabinet located in the laundry room. BEDROOMS: The facility has four (4) bedrooms, and all bedrooms are designated for residents' use. All residents' bedrooms observed to be nicely furnished with beds, night stands, lamps, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and a closet space. Additional linen is available inside each bedroom’s closet. Continue on LIC809-C BATHROOMS: The facility has two (2) bathrooms, both bathrooms are designated for residents’ and staff use. All bathrooms were observed to have the proper fixtures, grab bars, non-skid mats, trash cans with closed lids, paper towels and washing hands signs. The hot water delivered in the bathrooms measured at 10:15am to be at 115.7 degrees F. COMMON AREAS: These includes living room and a dining room. The living room was equipped with new furniture, a television, and coffee table. The dining area has a dining table to accommodate six (6) residents. There were no visible immediate hazards. The facility has comfortable temperature which was measured at 10:45am to be at 73 degrees F. LPA observed various activity supplies nicely stored inside the activity stand and ready for residents' use. LAUNDRY ROOM: The washer and dryer is located in a laundry area across from the kitchen. Laundry chemicals will be stored inside the separate storage area, which will always be locked and under supervision. MEDICATIONS/ Client/Staff Files: Medications will be kept inside the locked commercial storage cabinet next to the kitchen area. First Aid and the new manual is also locked inside the same cabinet. LPA observed the First-aid has all proper items and is current. Files will be kept inside separate locked cabinet located in the office area next to the dining room. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home were clear of obstruction. The backyard of the facility is properly fenced, has a patio and backyard furniture to accommodate six (6) residents. GARAGE: The garage is currently being used as storage for facility equipment, supplies and water. Garage is attached to the facility, however, has no access from the house. Continue on LIC809-C LPA observed the facility is clean, safe and sanitary. All window screens were in good repair. Auditory signals were installed on all exit doors. All passageways were free of obstruction. In addition to the Pre-Licensing inspection, a Component III power point presentation was also held. Pursuant to Title 22, CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised. An emergency exit plan/sketch along with other posting requirements were available and posted on the wall. No deficiency cited on today’s visit. Exit interview conducted and copy of this report signed and delivered to the Administrator.the state’s words, verbatim · CDSS document, Jul 2, 2025

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: Artur Vahramyan CEO/Anna Gasparyan Administrator Interview Method: Telephone interview On June 6,2025, 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, Jun 6, 2025