Grant Serenity Homes of Burbank

Allegation investigated: Resident went AWOL while in care of staff resulting in nasal fractures and multiple injuries.

Licensing Program Analyst (LPA) Nadia Shahbazian arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Administrator – Hasmik Mheryan. LPA explained the purpose of this visit is to deliver findings for the above allegation. On 09/16/25, LPA Shahbazian initiated a complaint investigation and conducted a health and safety check of the facility and requested copies of staff roster, resident roster and documents pertaining Resident 1 (R1). No health and safety concerns were observed during the visit on 09/16/25. On 10/12/25, 10/13/25, 10/23/25, and 11/12/25 the Department’s representative conducted interviews with staff, R1’s responsible party, and/or residents. On 10/30/25 the Department’s representative requested medical records. On 05/12/26 LPA Shahbazian condcuted a physical thour, no health and safety concerns were observed. LPA delivered findings for the above allegation. Continued 9099-C Substantiated Regarding allegation: Resident went AWOL while in care of staff resulting in nasal fracture and multiple injuries. It Is alleged that on 09/13/25 Resident #1 (R1) left the facility unattended, sustained a fall that resulted in a nasal fracture and bruises, subsequently being hospitalized. The investigation revealed the following: Interview conducted with Licensee revealed, licensee was called by Burbank Police Department and was notified that R1 was found and had gone missing from the facility. A caregiver from a registry agency was brought in to cover the shift. Based on interview with registry staff on 11/13/25, they stated they were not aware that the door alarm was not on. Caregiving agency staff stated they assisted R1 to sit in the living room as they assisted other residents and did not know R1 had walked out of the facility. When caregiving agency staff looked for R1 inside and outside the facility for 15 minutes, they received a phone call from the Fire Department, notifying them of R1’s hospitalization. Per caregiving agency staff, it was the responsibility of the previous shift staff to set the door alarm because caregiving agency staff did not know how to operate them. Per documents reviewed Physician’s report dated: 10/02/23 notes of dementia for R1. Incident report (SIR) dated: 9/14/25 submitted to the Department notes that on 09/13/25, a Caregiving Agency staff was called to provide care during the night shift, as facility’s evening shift staff had called out sick. SIR also notes, R1 had walked a distance from the facility and fell. A neighbor called 911, and R1 was taken to the hospital. Per Hospital Admissions Record dated: 09/13/25, R1 was admitted to the hospital on 09/13/25 after R1 sustained a ground level fall and was brought in by Emergency Responders (EMS). R1 was admitted to the hospital with an open fracture of nasal bone. Based on the information obtained, a Caregiving agency staff was covering the night shift on 09/13/25, during this shift R1 left the facility unattended, sustained a fall that resulted in an open nasal bone fracture. Therefore, the allegation is substantiated. Based on interviews and review of records obtained, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8, are being cited on the attached LIC 9099D. ***An immediate Civil Penalty of $500.00 is being issued today, due to resident sustaining an open nasal fracture while in care. Refer to LIC 421IM*** The issuance of a civil penalty is being considered based on Health & Safety Code 1569.49 (f); if the department determines the serious bodily injury was due to neglect. Exit interview conducted and a copy of this report, LIC9099D, and appeal rights were provided.the state’s words, verbatim · CDSS document, May 12, 2026 · control 31-AS-20250915150444

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: May 12, 2026

87468.1 (a)(2) - Personal Rights of Residents in All Facilities - (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodation ... This requiement was not met as evidenced by: Based on interview, and record review, staff failed to provide adequate supervion, resulting in Resident 1 to go AWOL and to get injured and hospitaled, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 12, 2026

Plan of correction: Administrator has laid off the staffing registry caregiver. Administrator has retrained all staff members in regards to personal rights. POC cleared during today's visit.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced Case Management visit, in conjunction with complaints dated 09/15/2025. LPA met with Hasmik Mheryan-Administrator and disclosed the reason for the visit. LPA requested copies of the Resident Roster, LIC and staff roster. LPA had previously obtained documents pertaining to complaint dated above. Based on the complaint and Incident report (SIR) dated: 9/14/25 submitted to the Department noted that on 09/13/25, a Caregiving Agency staff was called to provide care during the night shift. The agency staff did not turn on the auditory device on the front door, resulting in Resident 1 leaving the facility unsupervised and sustaining a fall, that resulted in nasal bone fracture and hospitalization. Based on record review, Resident 1 had dementia and diabetes. During today's visit LPA reviewed training records to ensure staff have been trained in resident's health and safety issues and to ensure auditory device on all the doors are functional. Administrator stated staff have been trained and staff were reminded not to leave residents unsupervised. Deficiency cited (refer to LIC 809D). Exit interview conducted, appeal rights and copy of report provided.the state’s words, verbatim · CDSS document, May 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(d) · Plan of correction due date: May 12, 2026

87705 - Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement... This requiement was not met as evidenced by: Based on interview and record review, staff failed to ensure auditory alarms are functional, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 12, 2026

Plan of correction: Administrstor has trained all staff regarding safety issues and staff will ensure that alarms on all doors are always on and functional. During today's visit LPA verified that all doors have functional alarms. POC cleared during today's visit.

Type of visit: Required - 1 Year

At 10:15AM Licensing Program Analyst (LPA), Nadia Shahbazian, conducted an unannounced annual inspection at the facility mentioned above. LPA met with Licensee - Ms. Nvard Gevorkian and Administrator Ms.Hasmik Mheryan and explained the reason for the visit. LPA used CARE inspection tool during the inspection. Facility is licensed to serve (6) non-ambulatory residents over the age of 60, of which (4) may be bedridden residents in bedrooms 1 and 4. Facility has an approved waiver for (2) hospice residents. At 11:15AM physical tour was conducted with the Administrator and LPA observed the following: Required postings were observed by the entry area and throughout the home. The smoke/carbon monoxide detectors are hardwired and interconnected. At 11:25am smoke/carbon monoxide detectors were tested and observed to be functional. The fire extinguishers are located by the entry door and in the kitchen. Both fire extinguishers were serviced on 09/04/2025. Facility conducts quarterly Fire/Earthquake drills; the last Fire/Earthquake drill was conducted on 10/01/2025. The auditory alarms on all exit doors were functional at the time of the visit. Common Areas: The living room and dining area appeared clean and were properly furnished. The living room has a television set and gaming cabinet. There is a non-operational fireplace in the living room, covered by a metal screen. The dining room is located next to the kitchen and is furnished with a table and chairs, appropriate for number of residents. Continued on 809-C Kitchen: At 11:35AM LPA toured the kitchen and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All food supplies were clearly marked with expiration dates. All appliances, surfaces and floors were clean and sanitary. All knives and sharp objects were observed to be locked in a kitchen drawer. The laundry washer and dryer are located in one corner of the kitchen and laundry detergents were observed to be locked in cabinets above the laundry machines. Bathrooms: The facility has one (1) bathroom, located between bedrooms #3 and #4. The bathroom contained paper towels and liquid soap, 2 lided trash cans, grab bars and a non-skid mat. Hot water temperature measured at 113.7°F. Bedrooms: The facility has four (4) bedrooms. Bedridden designated rooms are #1 and #4, each with an emergency exit. Bedrooms #1 and #4 are shared and bedrooms #3 and #4 are private. All bedrooms were clean and odorless and furniture was in good repair. Surrounding Grounds: LPA toured the back yard and observed one set up patio furniture at the side of the yard and another set under a covered patio; there is also furniture at the front yard. Garage is accessed from the front and is used as a storage and also to park cars. Emergency water and food supplies were stored in garage cabinets and in the refrigerator in garage. There are two tall water fountains, one in the backyard and one at the front yard but there is no pool. Facility has exit doors in bedrooms #1, #4, in the kitchen and by the office area but the front door is used as the main emergency exit. All passageways were observed to be clean and free of obstructions. Medications: There is a locked refrigerator in the kitchen, to store medications. There is a locked cabinet located in the kitchen for storing medications. LPA counted medications for 6 out of 6 residents and compared them to physician medication orders for accuracy of administration. LPA observed a complete first aid kit and first aid manual inside the front entry cabinet. Resident/Staff Files: All confidential staff and resident files are maintained in a locked cabinet, in the office area. LPA reviewed files for all six (6) residents for required documents. LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing requirements. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies were observed during the visit. Exit Interview conducted / A Copy of the Report Issued to the Administrator.the state’s words, verbatim · CDSS document, Nov 21, 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 Maricela Sosa and explained the reason for the visit. Facility is licensed to serve 6 non-ambulatory residents over the age of 60, of which (4) may be bedridden and (2) non-ambulatory, with a hospice waiver for (2). Facility is a single home located in a residential neighborhood an consist of (4) resident rooms, (1) bathroom, a kitchen, a living room, a dining room, a detached garage, a patio, a backyard and front yard. LPA Flores conducted a tour of the facility and observed the following: Facility is clean and in good repair indoor and outdoor. The living room has a fireplace which is covered with a metal stand. Facility has sufficient food supplies for at least (2) worth of perishables, and (7) days of non-perishables stored in the kitchen. Cleaning supplies, medication, and sharps were observed locked in kitchen cabinets. Laundry is located in the kitchen. Each resident bedroom has sufficient lighting, the required bedding and furniture. LPA observed bed rails in room #4(BR4) for resident #3(R3) and #4(R4). Bathroom was observed clean, with grab bars, skid mat, and in good repair. Water temperature was tested at 106.4 degrees F., which is within the required 105-120 degrees F. Facility has sound device in each exit door. Backyard has seating furniture under a cover patio. Fire extinguisher was observed and last checked on 10/9/24. All passageways are free of obstructions and debris. There are no large bodies of water in this facility. First aid kit was observed with all required items. Licensing posters were observed posted. LPA reviewed files and medication for (5) clients and (5) staff files. Administrator certificate was observed for Martin Adjian #6043740740 exp. date: 3/15/25. Staff #1(S1) was observed working at the facility. Per administrator staff began working on 10/10/24, fingerprint clearance was done on 10/7/24. (CONTINUED ON LIC 809C) Infection control plan and emergency disaster plans were reviewed and are in compliance. Deficiencies was noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Nvard Gevorkian and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 12, 2024