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Type of visit: Required - 1 Year

License Program Analysts (LPA) Luis De Leon conducted an unannounced annual required visit. LPA met with Caregiver Karine Chilingaryan who informed Administrator of today’s visit. Administrator Armen Markosian joined the visit a few minutes later. The purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory residents, age 60 and over. The facility is approved for one (1) bedridden resident and six (5) hospice waiver. The LPA use the Compliance & Regulatory Enforcement Tool (CARE) during today’s inspection. The visit consisted as follows: FACILITY PHYSICAL PLANT The facility is in a residential area and is made up of four (4) Resident bedrooms, two (2) full bathroom including a private bathroom, living room, Dining room, laundry room in the garage, front and backyard, and a detached car garage. There were no body of water observed in the property. REVIEW OF FILES Resident record review consisted of Admission Agreements, Identification and Emergency Info, Physicians Report, Consent Report, Individual Program Plan, Hospice plan for 2 residents, Personal Rights, and Centrally Store Medication. Staff record review consisted of Personnel Report, Health Screening, Criminal Record Statements, Fingerprint Clearance, and Training. LPA observed that S1-S4 were missing First Aid Certificate in file. In addition, S1 and S3 were missing Health Screening records. Deficiencies were noted and record in LIC-809D. Report continues on page LIC-809C... Observations during facility tour: Bedrooms were furnished with a bedframe, dresser, lamps, and chairs. LPA observed full bed rail for all four residents and physician’s orders for rails were on file for each resident. LPA observed that there was clean linen, bath towels, and personal hygiene with reasonable closet space available for Residents. Wall and floors are in good repair. Facility temperature was 73 degrees F as read from thermostat. Hallways were clean and free of obstructions. Kitchen appliances were in working order and clean. There is sufficient two (2) days of perishables and seven (7) day supply of non-perishable food. Dining room has sufficient seating area. Toilets, showers, and water faucets are found in compliance with Title 22 regulations for temperature and function. Restrooms were stocked and clean. The water temperature was tested and measured. It was found in compliance with Title 22 regulations between 105º and 120º F degrees. Sharps are locked inside a drawer in a kitchen island inaccessible to Residents. Also, disinfectants and cleaning supplies are locked and secured inaccessible to Residents under kitchen sink and in garage. Smoke detectors were observed in all bedrooms and carbon monoxide detectors were observed in living room around kitchen area. One (1) fire extinguisher was observed. Last fire drill and disaster drill was conducted on 10/1/2025. Front and back yards are free of hazards. Back yard has a shaded seating area for Residents to enjoy. The medications are centrally stored and locked in the staff room. The facility uses the Medication Administration Record (MAR) log to document medications given. LPA reviewed medications for all four (4) Residents. LPA observed that one prescribed medication was missing for one resident (R3). A deficiency is noted on LIC-809D. LPA conducted interviews with two staff and two residents. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC-809D page. Exit interview was held and copies of reports LIC-809, LIC-809C, LIC 809D, and Appeal Rights were discussed and provided to Administrator Armen Markosian.the state’s words, verbatim · CDSS document, Dec 11, 2025

Type of visit: Post Licensing

Licensing Program Analyst (LPA) S Vaid conducted a Post Licensing visit to the facility. LPA met with Karine Chilingaryan caregiver who allowed access to the facility. Administrator, Armen Markosian was informed and explained the reason for the visit. The facility has a fire clearance approved for 5 non-ambulatory residents of which 1 may be bedridden. The visit began with a tour of the facility. Resident rooms were randomly inspected and were observed to have sufficient space and furniture. Bathrooms had grab bars and non-skid mats. The water temperature measured between 105-120 degrees F. The common areas were observed to be appropriately furnished. The kitchen was inspected. The area was clean, and appliances seem to be operating properly. Food supply was adequate, and food was stored properly. There are no large bodies of water on the premises. The outside recreation area has a fence around the entire perimeter. Facility has an operating auditory device on exit doors, and LPA observed and its operational. Smoke detectors were working properly, fire extinguisher was fully charged and operational, chemical compounds and knifes were locked and inaccessible to clients. Staff files were not on the premises, staff files not reviewed. Resident files were randomly reviewed. All required documentation such as physician's reports and admission agreements were observed. The medication was inspected, and medications were reviewed. One deficiency cited on 809D page, exit interview conducted, copy of report and appeals rights provided.the state’s words, verbatim · CDSS document, Jan 30, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80066 · Plan of correction due date: Jan 30, 2025

Personnal records- 80066. Staff personnel records must be available at all times. Facility must ensure all staff records to be on the premises at all time for future inspection.the state’s words, verbatim · CDSS document, Jan 30, 2025

Plan of correction: Administrator will submit staff documents to LPA by 02/10/2025.

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Sanjay Vaid conducted an announced visit to the facility for purpose of a Pre-licensing evaluation. At today's visit Administrator Armen Markosian and consultant Ripa Tavitian were present. An application was submitted to CCLD for Initial license for RCFE. The requested capacity is for 5non-ambulatory and 1 bedridden resident. Structure: The facility is a single story house and located in a residential neighborhood area. Facility is 4 bedrooms, 2 bathrooms, kitchen, living room, staff office/dining area and Activity Room. The client bedrooms are spacious and will easily accommodate the client's furnishings. The yard has a covered, shaded area for table and chairs. The passageways, walkways, driveway are free from obstructions. The front, back and side areas are free of hazards and maintained in a good condition. Signal system: The facility has a delayed egress with key and code to enter into the facility and LPA observed and its operational. Bedrooms Residents: There is one bed in each client's bedroom. Each bedroom has one beds, one chairs, one night stand, one dresser, one closet and overhead lighting. Bathrooms: All toilet, wash basins and showers are working. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in client's closet and the personal hygiene supplies will be stored and locked in the file cabinet in the living room. Continued on 809C...... Emergency Phone Numbers, Exit Plan: The facility has a landline phone # and the phone number is (626) 888-7858. Tested & readily available for use in staff office. Fire Extinguisher located in the kitchen mounted on wall. Food Service: Dishes, cups and flat ware are stored in the kitchen cabinets, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored and locked in a kitchen cabinet. Food supply adequate stored in the kitchen and consists of the following: 2 days perishable and 7 days non-perishable. Smoke Detectors: There are six smoke detector/carbon monoxide detector(s) were tested & are inter-connected. Appliances: Stove burners, oven, microwave, washer, and dryer working properly. Each refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The client's bedroom is equipped with central air and heat. Toxins: All cleaning supplies and toxins are locked and stored under the sink and in the laundry room. Water Temperature: The hot water temperature in bathroom and kitchen was tested and measured between 105 and 120 degree degrees Fahrenheit as required. Medications, First-Aid Kit & Book: A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored and locked in a kitchen cabinet, available for staff use but inaccessible to clients. Clients' medication is centrally stored and locked in the cabinet. Clients & Staff Files: Records of staff and clients shall be stored in a locked file cabinet in the staff room. The client and staff files are stored and locked in the file cabinet in the office /dining room. Component III: Administrator has other facility and waived the component III presentation facility compliance. An exit interview was conducted and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): COMP II Participants: Armen Markosian (A), Varduhi Nushikyan (C) Interview Method: Telephone interview On October 24, 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. Medications/Activities 3. Staffing requirements & Client advertising 4. Pre Licensing inspection readinessthe state’s words, verbatim · CDSS document, Oct 24, 2024