Dignity First Assisted Living Facility

Allegation investigated: Staff do not safeguard residents personal belongings. Staff are not providing an authorized representative access to a resident's records. Staff does not ensure resident's personal finances are safeguarded. Staff did not provide authorized representative with an admissions agreement. Resident was over medicated by facility staff.

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced complaint visit on 09/04//2026 to deliver findings related to the above allegations. LPA met with Pauline Halladjian, Admin & Kevork Halladjian,Licensee explained the purpose of the visit, and was granted entry to the facility. The investigation included a review of the resident roster, staff roster, R1’s Face Sheet, Physician’s Report, hospice agreement, unsigned Admission Agreement dated 08/21, Medication Administration Record (MAR), personal belongings pickup/receipt, and Special Incident Report (SIR) regarding R1’s hospitalization. LPA conducted interviews with four (4) staff members (S1–S4) and one (1) witness (W1).LPA attempted to interview three (3) residents; however, due to medical conditions, cognitive limitations, and language barriers, LPA was unable to obtain meaningful statements from the residents.Additionally, LPA toured the facility and observed resident bedrooms, bathrooms, common areas, kitchen, medication storage area, exterior grounds, swimming pool area, and general facility conditions. Unsubstantiated Allegation: Staff do not safeguard residents’ personal belongings. It is alleged that facility staff failed to safeguard R1’s personal belongings. Specifically, concerns were raised that an individual may have had access to R1’s personal belongings and/or personal documents without verified authorization. It was further alleged that the individual may have obtained permission from R1 to access R1’s private residence for the purpose of retrieving personal documents and manuscripts. Review of the facility’s visitation logs did not identify any record indicating that the individual in question visited R1 while R1 resided at the facility. During interviews, staff reported they were unaware of R1 providing the individual authorization to access R1’s private residence and/or personal documents. Staff further reported no knowledge of the individual accessing or removing R1’s belongings from the facility. Records reviewed indicated that R1 was admitted to the facility on 08/21/2026 and was hospitalized on 08/23/2026. R1 did not return to the facility following the hospitalization. S1 reported visiting R1 at the hospital on 08/24/2026 at approximately 5:04 p.m. S1 stated that R1’s relative was present during the visit and that R1 provided S1 with verbal authorization to allow the relative to retrieve R1’s belongings from the facility. S1 reported that R1’s belongings were released to the relative based on R1’s authorization. The facility’s Personal Belongings Pick-Up Receipt documented that on 08/26/2026, R1’s relative retrieved R1’s belongings, which included a cellular phone, keys, clothing provided by the facility, and paperwork/documents. Allegation: Staff are not providing an authorized representative access to a resident’s records. It is alleged that facility staff failed to provide R1’s authorized representative access to R1’s records. Specifically, concerns were raised that R1’s authorized representative requested access to R1’s facility records and was not provided the requested documentation. During the interview, S1 reported that since becoming acquainted with R1, S1 was not aware of R1 having a Power of Attorney (POA). S1 stated that R1 coordinated R1’s own placement at the facility based on a recommendation from a friend. During record review, LPA did not observe documentation identifying a POA or other legally authorized representative for R1. Additionally, W1 reported that records available to W1 identified R1’s relative as a designee and/or emergency contact only and did not identify the relative as R1’s POA. Allegation: Staff does not ensure resident’s personal finances are safeguarded. It was alleged that facility staff failed to safeguard R1’s personal finances. Specifically, concerns were raised that an individual may have been involved in R1’s financial affairs and may have had access to R1’s finances and/or financial information without verified authorization. During interviews, staff reported they were not aware of any concerns regarding R1’s personal finances, as R1 had not expressed any financial concerns to staff. Staff also reported they were unaware of any concerns or suspicions involving a specific individual having access to or involvement with R1’s finances. S1 reported that R1 had agreed with the facility to pay for R1’s stay and services provided by the facility. However, R1 resided at the facility from 08/21/2026 through 08/23/2026, when R1 was hospitalized and did not return to the facility. S1 reported that the facility did not receive any payment from R1 for the stay or services provided.. (continued on 9099C) Allegation: Staff did not provide authorized representative with an Admission Agreement. It is alleged that facility staff failed to provide R1’s authorized representative with a copy of R1’s Admission Agreement. Specifically, concerns were raised that R1’s representative was not provided a copy of the Admission Agreement following R1’s admission to the facility. During interviews, S1 and S2 reported that R1 signed R1’s own hospice agreement with Kaiser prior to placement at the facility. S1 and S2 further reported that R1 did not provide documentation or indicate that R1 had a Power of Attorney (POA). Staff reported that R1 arranged R1’s own admission to the facility and was expected to review and sign the Admission Agreement. S1 and S2 reported that they were never asked by R1’s relative, representative, or any other individual to provide R1’s Admission Agreement, resident records, or any other documentation pertaining to R1. S1 reported that R1 arrived at the facility late on 08/21/2026. On 08/22/2026, R1 was resting and indicated the Admission Agreement would be signed at a later time. On 08/23/2026, R1 experienced a change in condition and was hospitalized before the Admission Agreement was signed. R1 did not return to the facility following the hospitalization. S1 provided LPA with R1’s Admission Agreement. LPA observed that the agreement was unsigned. During record review, LPA did not observe documentation identifying a POA or other authorized representative for R1. Additionally, W1 reported that the records available to W1 did not identify or contain documentation of a POA for R1. LPA also obtained and reviewed a copy of the hospice agreement, which contained R1’s signature. Allegation: Resident was overmedicated by facility staff. It is alleged that R1 was overmedicated by facility staff. Specifically, concerns were raised that R1 may have received excessive medication while residing at the facility, resulting in a change in R1’s condition, including becoming nonverbal and unresponsive, which subsequently resulted in R1 being transported to the hospital for further medical evaluation. S2 reported that when R1 was admitted to the facility on 08/21/2026, R1 arrived without medications. S1 and S2 reported that R1 was upset and requesting R1’s medications. S1 reported that on Saturday, 08/22/2026, S1 went to Kaiser in Baldwin Park to obtain R1’s prescribed medications. Staff reported that the facility did not obtain R1’s medications until later in the day on 08/22/2026, at which time the facility updated R1’s MAR and documented the medications provided to R1. During record review, LPA reviewed R1’s Medication Administration Record (MAR) for 08/22/2026, as R1 arrived at the facility late on 08/21/2026. LPA observed that medications documented on the MAR were administered in accordance with the orders available for review. During interviews, staff reported assisting R1 with medications as prescribed. A copy of R1’s MAR and corresponding physician’s medication orders were provided to LPA for review. S2 reported that on 08/23/2026, after R1 was transported to the hospital, an attending emergency room physician contacted S2 because the hospital did not have R1’s medication orders and needed information regarding R1’s prescribed medications. S2 stated that the facility provided the physician with the available medication orders and medication log documenting the medications administered to R1. According to S2, during the conversation, the emergency room physician stated that Kaiser had been overmedicating R1. Based on the investigation conducted, which included interviews with staff and witness, as well as a review of relevant records, there was insufficient evidence to support the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 4, 2026 · control 28-AS-20260902151909

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Gabriela Castro conducted an unannounced required annual visit using the Compliance and Regulatory Enforcement (CARE) Tool. LPAs were greeted by Kevork Halladjian, Licensee and explained the purpose of the visit. The facility is licensed to serve six (6) non-ambulatory residents, ages 60 and over. One (1) resident may be bedridden in Bedroom #3. The facility has an approved hospice waiver for six (6) residents. At the time of the visit, there were two residents under hospice care. FACILITY TOUR AND OBSERVATIONS: During the facility tour, LPA observed Personal Rights postings displayed in a common area and accessible to residents. Residents had access to personal space, privacy, and adequate storage for their belongings. No firearms or other weapons were observed on the premises. Physical Plant The facility is a two-story home located in a residential neighborhood. The home consists of three (3) bedrooms, two (2) bathrooms, one (1) half-bathroom for staff located near the dining area, a kitchen, two (2) living rooms, dining area, laundry area, backyard with a swimming pool and pool house, and an attached garage. The laundry room area contains stairs that lead to the second-floor caregiver corridor. The second floor is inaccessible to residents and is designated for caregiver/staff use. The facility also has an additional attached room/bedroom that is currently utilized as an office. This room has a separate exterior entrance and is not accessible from the interior resident living area. (continued on 809C) The backyard contains a swimming pool enclosed by fencing that was observed to meet regulatory requirements. The front and backyard areas contained shaded seating available for resident use. Passageways and exits were observed to be clear and unobstructed. Smoke and carbon monoxide combination detectors were observed, tested, and found to be operational. A fire extinguisher located in the dining area was observed to be charged. Appliances, including the microwave, refrigerator, and stove, were observed to be clean and operating properly. Sharps and chemicals were observed to be secured and inaccessible to residents. Water temperature was measured and observed to be within the regulatory range of 105°F to 120°F. Extra linens and towels were available and stored in a hallway closet. Smoke and carbon monoxide detectors were tested and found operational. LPA observed that the door alarms on the exit door in bedroom three (3) and areas of the home that were functioning. Food Service Refrigerators and freezers were maintained at proper temperatures (refrigerators at a maximum of 40°F and freezers at 0°F) and contained a sufficient supply of food, including at least two (2) days of perishable food and seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were stocked. Health-Related Services & Records Three (3) resident files were reviewed. Files contained required documentation, including Admission Agreements, signed consents, Needs and Services Plans, Physician’s Reports documenting ambulatory status, and Resident Rights acknowledgments. However, all three (3) resident files reviewed did not contain documentation of proof of tuberculosis (TB) clearance. Three (3) residents’ medications were also reviewed. Medications were observed to be centrally stored and secured in a locked kitchen cabinet. During the medication review, LPA observed discrepancies between the Medication Administration Records (MARs) and the medications reviewed. Specifically, R1’s MAR was not maintained accurately, as it did not document whether R1 received or did not take the prescribed evening medications.Deficiencies regarding the missing TB documentation and inaccurate medication records will be cited. Disaster Preparedness Last fire/earthquake drill was conducted on August8, 2026.. LIC 610D Emergency Disaster Plan was observed to be updated. Emergency supplies (water, food, flashlights, batteries, first aid) were observed. (continued on 809C) Personnel Records & Training Three (3) staff files were reviewed and contained documentation of criminal record clearances, CPR/First Aid certification, and TB clearance. However, LPA did not observe documentation of required staff training for S2 and S3. A deficiency will be cited. An exit interview was conducted with Pauline Halladjian, Administrator and Kevork Halladjian, Licensee. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided.the state’s words, verbatim · CDSS document, Sep 4, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Sep 25, 2026

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met by evidence by: During the medication review, the facility was unable to provide a Medication Administration Record (MAR) documenting whether R1’s prescribed evening medications were administered or not administered which poses/posed an immediate health and safety, personal rights to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2026

Plan of correction: Administrator shall conduct a review of all residents’ MARs to ensure that medication administration, refusals, and medications not administered are properly documented. Administrator shall provide medication documentation training to all staff responsible for assisting residents with medications. Proof of correction shall include a written statement confirming completion of the MAR review, copies of corrected/current MARs, and documentation of staff training, including training date, topics covered, and staff signatures, submitted to LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(c)(1))A) · Plan of correction due date: Sep 25, 2026

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis...(A) Communicable tuberculosis. During the resident record review, LPA observed that three (3) out of three (3) resident files reviewed did not contain documentation of tuberculosis (TB) clearance which poses/posed a potential threat to the health and safety, personal right to residents in care. This requirement is not met by evidence by: During the resident record review, LPA observed that three (3) out of three (3) resident files reviewed did not contain documentation of tuberculosis (TB) clearance which poses/posed a potential threat to the health and safety, personal right to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2026

Plan of correction: Administrator shall obtain and maintain documentation of TB clearance for R1, R2, and R3. Administrator shall also review all resident files to ensure required TB documentation is complete and maintained in each resident’s record. Proof of correction shall be submitted to LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Sep 25, 2026

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met by evidence by: During the staff record review, LPA did not observe documentation of required staff training for S2 and S3 which poses/posed a potential threat to the health and safety, personal rights to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2026

Plan of correction: Administrator shall ensure that S2 and S3 complete all required training and that documentation of completed training is maintained in their personnel files. Administrator shall review all staff files to ensure required training is current and properly documented. Proof of training shall be submitted to LPA by the POC due date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced Case Management visit to the facility and was greeted by Owner Kevork Halladjian and the purpose of the visit was explained. The reason for the visit is to rescind the report issued on 5/8/26 in which the deficiency issued 1569.52(c) shall be changed to a better fitting citation 87507(g)(5)(A) Case Management visit was conducted on 5/8/26 and included the following: The reason for the visit is on 12/18/2025 during the course of a complaint investigation # 28-AS-20251212145452 the following was observed: LPA reviewed the Admission Agreement for Resident R1 and listed under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances. Deficiency to be issued Health and Safety Code 1569.652 (c) on the 809 D page. Facility needs to update or add additional information to the refund policy. Deficiency cited on the 809D. Exit interview conducted and copy provided.the state’s words, verbatim · CDSS document, Jun 19, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(A) · Plan of correction due date: Mar 15, 2026

Admission Agreement Admission agreements shall specify the following: Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement is not met as evidenced by: Licensee has listed on the Admission Agreement for Resident R1 under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Jun 19, 2026

Plan of correction: Licensee to update or add additional information to the refund policy on the Admission Agreement and send proof to Licensing by POC due date. Deficiency cleared on 5/13/26.

Type of visit: Case Management - Deficiencies

LPA Glenn Trueman made an unannounced Case Management visit to the facility and was greeted by Owner Kevork Halladjian and the purpose of the visit was explained. The reason for the visit is to rescind the report issued on 5/8/26 in which the deficiency issued 1569.52(c) shall be changed to a better fitting citation 87507(g)(5)(A) Case Management visit was conducted on 5/8/26 and included the following: The reason for the visit is on 12/18/2025 during the course of a complaint investigation # 28-AS-20251212145452 the following was observed: LPA reviewed the Admission Agreement for Resident R1 and listed under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances. Deficiency to be issued Health and Safety Code 1569.652 (c) on the 809 D page. Facility needs to update or add additional information to the refund policy. Deficiency cited on the 809D. Exit interview conducted and copy provided.the state’s words, verbatim · CDSS document, Jun 17, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(A) · Plan of correction due date: Mar 15, 2026

Admission Agreement Admission agreements shall specify the following: Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement is not met as evidenced by: Licensee has listed on the Admission Agreement for Resident R1 under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances which poses a potentail risk to residents in care.the state’s words, verbatim · CDSS document, Jun 17, 2026

Plan of correction: Licensee to update or add additional information to the refund policy on the Admission Agreement and send proof to Licensing by POC due date. Deficiency cleared on 5/13/26.

Allegation investigated: Staff did not issue a refund to a resident in care.

The purpose of this visit 5/8/2026 is to reissue citation and to include additional information. The initial visit was conducted on 12/18/2025 and included the following: Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Owner Kevork Halladjian and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegation. At today's visit the following was done: Owner Kevork Halladjian was interviewed. Staff S1 was interviewed. Administrator was interviewed telephonically. Attempts were made to interview Resident R1 were unsuccessful with being unable to respond to questioning. Interview was conducted with the Administrator telephonically. Interview was conducted with the Hospice Agency Nurse. Substantiated File was reviewed for Resident R1 and Death Report, Physician's Report and Admission Agreement to be submitted. Resident and Staff Roster submitted, File of Resident 1's Hospice agency was reviewed. In regards to the allegation Staff did not issue a refund to a resident in care, based on interviews conducted and information gathered the Owner and the Administrator both confirmed that Resident R1 did not get a refund with Admission date 12/04/25 and passing away on 12/05/25. Administrator stated that there was no refund based on having to prep the room and time it will take to get another resident. Owner stated he said no to a refund because family agreed that if it's 1 day or 30 the month is paid in full. Said that family had a contract with the Hospice Agency. Staff S1 stated that Resident R1 was only here for 1 day and was declining. Nurse from Hospice Agency stated that they are only paid by reimbursement from Medicare and that there is not a contract between resident and Hospice. Personal belongings of Resident R1 were picked up from the facility on 12/05/2026. This was confirmed by Owner Kevork Halladjian, Administrator, Staff S1 and family member of Resident R1. LPA reviewed and obtained R1's Admission Agreement. The agreement indicates "No refunds will be issued under any circumstances". Facility refund policy is not in compliance with Title 22 and Health and Safety Code and is addressed on a Case Management visit dated 5/8/2026. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. Exit interview conducted and copy provided to Owner Kevork Halladjian.the state’s words, verbatim · CDSS document, May 8, 2026 · control 28-AS-20251212145452

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: May 15, 2026

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by Resident R1's death was on 12/05 and facility would not refund for 12/6-12/31 with Personal belongings of Resident R1 were picked up from the facility on 12/05/2026. This was confirmed by Owner Kevork Halladjian, Administrator, Staff S1 and family member of Resident R1 which poses a potential risk to residents in care. which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Facility by the POC due date will issue a refund for the days pre-paid after the passing of R1 on 12/5.(12/6-12/31) and submit proof to licensing by 5/15/2026.

Type of visit: Case Management - Other

LPA Glenn Trueman made an unannounced Case Management visit to the facility and was greeted by Owner Kevork Halladjian and the purpose of the visit was explained. The reason for the visit is on 12/18/2025 during the course of a complaint investigation # 28-AS-20251212145452 the following was observed: LPA reviewed the Admission Agreement for Resident R1 and listed under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances. Deficiency to be issued Health and Safety Code 1569.652 (c) on the 809 D page. Facility needs to update or add additional information to the refund policy. Exit interview conducted and copy provided.the state’s words, verbatim · CDSS document, May 8, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: May 15, 2026

Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Licensee has listed on the Admission Agreement for Resident R1 under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances which poses a potentail risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Licensee to update or add additional information to the refund policy on the Admission Agreement and send proof to Licensing by POC due date.

Allegation investigated: Staff did not issue a refund to a resident in care.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Owner Kevork Halladjian and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegation. At today's visit the following was done: Owner Kevork Halladjian was interviewed. Staff S1 was interviewed. Administrator was interviewed telephonically. Attempts were made to interview Resident R1 were unsuccessful with being unable to respond to questioning. Interview was conducted with the Administrator telephonically. Interview was conducted with the Hospice Agency Nurse. File was reviewed for Resident R1 and Death Report, Physician's Report and Admission Agreement to be submitted. Resident and Staff Roster submitted, Substantiated File of Resident 1's Hospice agency was reviewed. In regards to the allegation Staff did not issue a refund to a resident in care, based on interviews conducted and information gathered the Owner and the Administrator both confirmed that Resident R1 did not get a refund with Admission date 12/04/25 and passing away on 12/05/25. Administrator stated that there was no refund based on having to prep the room and time it will take to get another resident. Owner stated he said no to a refund because family agreed that if it's 1 day or 30 the month is paid in full. Said that family had a contract with the Hospice Agency. Staff S1 stated that Resident R1 was only here for 1 day and was declining. Nurse from Hospice Agency stated that they are only paid by reimbursement from Medicare and that there is not a contract between resident and Hospice. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. Exit interview conducted with Staff S1 and copies of the report given.the state’s words, verbatim · CDSS document, Dec 18, 2025 · control 28-AS-20251212145452

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Dec 26, 2025

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by Resident R1's death was on 12/05 and facility would not refund for 12/6-12/31 which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Dec 18, 2025

Plan of correction: Facility by the POC due date will issue a refund for the days pre-paid after the passing of R1 on 12/5.(12/6-12/31) and submit proof to licensing by 12/26.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an announced Pre-Licensing inspection visit. LPA met with Administrator Pauline Halladjian and Kevork Halladjian explained the reason for the visit. The facility has an approved fire clearance to be licensed to serve six (6) residents; five (5) non-ambulatory and one (1) bedridden. Bedroom #3 with direct exiting to the exterior shall house the one (1) bedridden resident. All other rooms will be non-ambulatory. LPA and Applicant toured the physical plant interior and exterior. The Pre-Licensing Inspection CARE Tool was used. The following was observed/inspected: The facility is a two-story home located in a residential neighborhood of Glendora. The home consists of 3 bedrooms, 2 bathrooms, and hal-bath for staff located near dining area, kitchen, two (2) living rooms, dining area, laundry area, backyard with a pool and an attached garage. The second floor is inaccessible to residents and will be utilized as an office and staff area. Smoke and carbon monoxide combination detectors observed, tested and are operable. The fire extinguisher located in the dining are was observed and charged. Appliances such as a microwave, refrigerator and stove were observed to be clean and operating properly. Sharps were observed secured under the kitchen sink, inaccessible to residents. continued on LIC 809C continued from LIC809, page 2 Centrally stored medication will be located in a locked cabinet located in the kitchen. Staff and client files will be maintained locked in a cabinet located in a hallway closet. Dining area was observed clean with sufficient seating for six (6) residents. Fireplace in dining area is not operational. Living rooms were observed free of obstructions with sufficient seating and space to promote and facilitate the program of activities. Fireplace in the living room had a covered screen. All cleaning solutions and disinfectants were observed locked under the kitchen sink, laundry area and garage. Grab bars and non-skid mats were observed in the hallway bathroom. The shower in the private bathroom located in a resident bedroom will not be utilized. The water temperature was tested in both bathrooms and measured at 116 and 112.6 degrees F, within the required 105-120 degrees F. Residents’ bedrooms have all required furniture which include, for each resident, a bed equipped with good springs, a clean and comfortable mattress, available pillow(s) and lightweight warm bedding, fillings and covers for mattresses and pillows were flame retardant, a chair, nightstand, a lamp, or lights sufficient for reading, and a chest of drawers. Bed linens were clean and in good repair. There was closet space for clothing and other belongings. Extra clean linens were observed in the hallway storage cabinet. No bedroom of a resident shall be used as a passageway to bathroom or outdoors. Doors, exits, hallways, and passageways were clear and free of obstruction. The front and back yards were observed to be clean and free of debris. LPA observed the backyard to have a covered seating area with sufficient seating for six (6) residents and a pool which was made inaccessible through fencing. LPA observed a locked pool gate that opens away from pool and self-latches. LPA observed the surrounding area did not have any objects that can be used to climb over the fence. continued on LIC 809 page 3 Backyard contained a pool house for private use, locked and inaccessible to residents. Per facility sketch (additional area 2) contains separate, private living quarters, possibly for staff. LPA provided applicant with the following information: • PIN 24-03-ASC, Subject: Safety Requirements for Facilities with Pools and Other Bodies of Water • LIC 311F, Records to be Maintained at the Facility- Residential Care Facility for the Elderly Comp III was completed during today’s visit with applicant Pauline Halladjian. The Pre-licensing is complete, and the facility has no deficiencies. An exit interview was conducted, and a copy of this report has been provided to 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, Sep 4, 2025