Grant Serenity Homes of Pasadena

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nune Margaryan conducted an Annual Required visit and inspection of the facility. LPA met with staff David Fontecha. Shortly after Administrator Diana Castellanos arrived and assisted with the visit. LPA explained the purpose of the visit. During the visit, the CARE tool was used. The facility is licensed to serve 6 non-ambulatory residents age range 60 and over, of which 1 may be bedridden and hospice waiver for 6. The facility has 6 bedrooms, 1 bathroom, a dining room, a living room, a detached garage, a detached laundry room, back patio and a front yard. The facility is a single-story home, located in a residential area, that consists of a living room, dining room, six (6) resident bedrooms, one (1) bathroom, a kitchen, and detached garage. Laundry room was observed at the back of facility. All indoor and outdoor passageways were free of obstruction. The front and backyard are well maintained. No pools and bodies of water on the premises. There is a shaded seating area for the residents located in the backyard. The kitchen was inspected. LPA observed all kitchen equipment to be clean and in working condition. LPA observed sufficient supply of perishable and non-perishable foods. Additional food supplies observed in the garage. Appliances such as a microwave, refrigerator and stove were observed to be clean and operated properly. Sharps are locked and inaccessible to residents. Cleaning solutions and disinfectants was observed locked in the laundry room. The common areas (dining room, living room) are clean and were properly furnished. Resident rooms were sanitary and had the required furniture and furnishings. There is closet space for clothing and other belongings. Extra clean linen were observed in each residents room. The resident bathroom is clean and operational w/grab bars and non-skid surface/mats in place. The hot water temperature was tested and maintained within the required range of 105-120*F. Fire extinguishers were observed at the facility fully charged (1 in the kitchen and 1 in the living room). Continue 809C Carbon monoxide / Smoke detectors were observed throughout the facility and were tested and operable. Auditory alarm devices to monitor exits were operable. Last fire drill was conducted on 11/05/2025. The first aid kit was observed and found to be in compliance with the Title 22 Regulations LPA reviewed clients and staff files. LPA observed that Staff 1 (S1) did not have a criminal record clearance. LPA reviewed clients medications. Medications are documented properly and given as prescribed. Deficiency cited, civil penalty was issued. An exit interview was conducted. A copy of this report with appeal rights were provided to Administrator.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA)s Mary Flores and Nicol Wesley conducted an unannounced annual visit at the facility using the CARE inspection tool. LPAs met with David Fontecha and explained the reason of the visit. The facility is licensed to served 6 non-ambulatory residents age range 60 and over, of which 1 may be bedridden and hospice waiver for 6. The facility has 6 bedrooms, 1 bathroom, a dining room, a living room, a detached garage, a detached laundry room, back patio and a front yard. LPAs conducted a tour of the facility with Juan Fontecha and observed the following: Facility is in good repair inside and outside. Living and dining area are clean and have sufficient sitting area for activities. Kitchen is clean, food was observed sufficient for at least 2 days of perishables and 7 days of non-perishables. Current residents do not have special diets. Sharps were observed locked on a drawer and cleaning supplies were observed locked under the sink. Six (6) resident's rooms were observed and each has sufficient lighting, furniture, and bedding supplies. Bedroom #1 has a covered fireplace. Full bed rails were observed in bedroom #4. Bathroom was observed with skid mat, grab bars and water temperature was tested at 118.5 degrees F., which is within the required 105-120 degrees F. Garage is used for storage of emergency food supplies and infection control supplies. The backyard was observed clean and has a shaded seating area. Due to the winds backyard fence was knocked down and observed on the floor. Administrator will ensure that is clean up by 1/20/25. Interlace smoke/carbon monoxide detectors were tested during the visit and in working condition. Fire extinguishers were observed and last checked on 10/8/24. There are no large bodies of water at the facility. License, PUB 475 Let us Know poster, Long Term Care Ombudsman poster, personal rights were posted in the dining area. (CONTINUED ON LIC 809C) LPAs reviewed medication and files for 5 residents. Resident #2(R2) in bedroom #4 has half bed rail request on file and per file review is not on hospice. LPAs reviewed 5 staff files. Training was observed for all residents. Administrator certificate was observed for Diana Castellanos #6073850740 exp. date: 1/6/27. LPAs reviewed infection control plan and disaster emergency plan. Last fire drill was conducted on 11/6/24. A deficiency has been noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Mariam Nikogsyan and provided a copy of report, LIC 809D, and appeal rights.the state’s words, verbatim · CDSS document, Jan 16, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Hakob Gevorkyan and explained the reason for the visit. The facility is licensed to served 6 non-ambulatory residents age range 60 and over, of which 1 may be bedridden and hospice waiver for 6. The facility has 6 bedrooms, 1 bathroom, a dining room, a living room, a detached garage, a detached laundry room, back patio and a front yard. LPA Flores conducted a tour of the facility with Hakob Gevorkyan and observed the following: Facility is in good repair inside and outside. Living and dining area are clean and have sufficient sitting area for activities. Kitchen is clean, food was observed sufficient for at least 2 days of perishables and 7 days of non-perishables. Sharps were observed locked on a drawer and cleaning supplies were observed locked under the sink. Resident's rooms (6) were check and each has sufficient lighting, furniture, and bedding supplies. Bedroom #1 has a covered fireplace. Bathroom was observed with skid mat, grab bars and water temperature was tested at 86.3 degrees F., which is not within the required 105-120 degrees F. Garage is used for storage of emergency food supplies and infection control supplies. The backyard was observed clean and has a shaded seating area. Interlace smoke/carbon monoxide detectors were tested during the visit and in working condition. LPA did not observed PUB745 - Let us know poster posted at the facility. Fire extinguishers were observed and last checked on 10/19/23. LPA reviewed medication and files for 5 residents. Resident #4(R4)'s medication was observed without prescription labels and out of the original container. Resident #3(R3) did not have a pre-appraisal on file. LPA reviewed 5 staff files and no record of initial or annual training was observed in files for staff #2-5(S2-S5). LPA reviewed infection control plan which was last reviewed on 7/1/22 and disaster emergency plan which was last reviewed on 6/1/21. Last fire drill was conducted on 10/1/23. (CONTINUED ON LIC 809C) Administrator certificate was posted for Nvard Gevorkian#6050643740 and exp. on 12/23/24. No record of designee letter was observed and facility has assigned staff #4 and #5 as the designee staff. LPA interviewed 2 staff and 2 residents. Deficiencies were noted during this visit on LIC 809D per Title 22 Regulations. Exit interview was conducted with Nvard Gervokian administrator and a copy of this report, LIC 809D, technical violations, and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 2, 2023

The state marks this report as 9 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.