A-1 Ascended Senior Care 3

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual inspection and met with the Administrator and explained the reason for the visit. A tour of the physical plant was initiated at 11:50am and the following were observed: Facility is approved for six (6) Non-ambulatory, of which six (6) may be Bedridden. Facility also has a hospice waiver granted for six (6) residents. The facility maintains a comfortable temperature at 73°F. KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, microwave oven and sink. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The fire extinguisher is located by the kitchen and was last serviced on 02/19/2026. BEDROOMS: There are six (6) bedrooms designated for resident's’ use. Bedrooms are appropriately furnished and have appropriate lighting. Facility has awake staff at night. BATHROOMS: The facility has two (2) bathrooms. LPA observed all bathrooms have non-skid mat, soap, paper towels and hand washing signs. Extra towels and linens were readily available. The hot water temperature measured at 120°F. Continue on LIC809-C MEDICATION ROOM: At approximately 12:00pm, LPA observed medications are centrally stored and locked, in the metal cabinet, located in the dining area, and inaccessible to residents in care. The first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. LAUNDRY ROOM: The laundry room is located by the garage. The washer/dryer appears to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. COMMON AREAS: These include a dining area and a living room. The common areas are furnished with adequate furniture to accommodate a maximum capacity of six (6) residents. At 12:15pm, smoke and carbon monoxide detectors were tested and observed to be operable. There were no visible immediate hazards. SURROUNDING GROUNDS: At approximately 12:20pm LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA discussed the importance of maintaining care and supervision to meet the needs of residents. There are no bodies of water. Between 12:30pm to 1:00pm, LPA reviewed records of three (3) residents and two (2) staff. Resident and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500. No citations were issued during this visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Apr 15, 2026

Type of visit: Required - 1 Year

At 12:40pm, Licensing Program Analysts (LPAs) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the Administrator and explained the reason for the visit. At 12:45pm LPA conducted a tour of the physical plant and observed the following: Facility is approved for six (6) Non-ambulatory, of which six (6) may be Bedridden. Facility also has a hospice waiver granted for six (6) residents. There are six (6) bedrooms designated for residents’ use. Facility maintains a comfortable temperature of 77°F. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. All knives were observed to be locked in the kitchen drawer. The fire extinguisher is located in the hallway by the kitchen area and was last serviced on 02/19/2025. Medications are stored in a locked cabinet, located in the hallway. There is a complete first-aid kit in the cabinet with all required supplies and with the first aid manual. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and all trash cans have a lid. Extra towels and linens were readily available. The hot water temperature measured at 115.5°F. Laundry is located in the garage. The washer/dryer appear to be in good condition. Laundry supplies, chemicals and detergents are kept in the garage and inaccessible to residents in care. Smoke detectors and carbon monoxide monitors were tested at 2:00pm and observed to be functional. At 2:05pm, LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA also observed sufficient yard space with fenced backyard. The outdoor area was free of visible immediate hazards. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. Continue on LIC809-C Between 2:10pm to 2:30pm, LPA reviewed records of three (3) residents and one (1) staff. Resident and staff records appeared to be complete and updated. Resident’s files contain signed admission agreements and a medical assessment, and all other required documentarians. LPAs collected Certificate of Liability Insurance, Administrator Certificate and LIC500. No citations issued during this visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 20, 2025

Type of visit: Prelicensing

At 10:30am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-Licensing Inspection at this facility, met with Licensee Aida Manukyan and Administrator Bruce R. Partridge. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. Today's site visit consisted of touring the physical plant inside and outside. A tour of the physical plant was initiated at 10:40am and the following was observed: Fire Clearance was approved on 01/29/2024 for a maximum capacity of six (6) residents, of which six (6) Non-Ambulatory, six (6) may be Bedridden and Hospice waiver granted for six (6). The facility currently has no residents, but plans on operating at full capacity six (6). The facility is a one story building with six (6) bedrooms and three (3) bathrooms. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supply of nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. BEDROOMS: There are six (6) bedrooms designated for residents’ use. All six bedrooms are designated for private use. Currently, Room #2 is used as the model bedroom. Room #3 was equipped with bed, nightstand, chair, dresser bedding and linen. Rooms #1, #3, #4, #5 and #6 were not furnished at this time. Rooms were observed to have sufficient lighting and closet space. Per STD 850, all six (6) bedrooms are cleared for Bedridden residents. Continue on LIC809-C BATHROOMS: At 10:50am LPA observed three (3) bathrooms are clean and in good repair. Properly supplied with toilet papers, soap, and paper towels. The hot water temperature measured 120°F. Bathrooms observed to have appropriate grab bar and non-skid mat. Bathroom #1 is located in the hallway beside bedrooms #3 and #4. Bathroom #2 is located inside bedroom #2 for private use. Bathroom #3 is located beside bedroom #6. MEDICATION: The medications will be kept in the separate area in the dining room and LPA observed the cabinet kept locked and inaccessible to residents in care. COMMON AREAS: The facility maintains a comfortable temperature at 71°F. The living room and dining appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. The fireplace located in the living room and dining room is adequately closed and inaccessible. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 10:55am they were tested and observed to be operational. FIRE EXTINGUISHER was last purchased on 4/15/2024 is located in the kitchen and 2nd one is located in the garage. First-aid is complete and new. SURROUNDING GROUNDS: In the back of the facility has sufficient yard space. The team observed appropriate outdoor furniture, with a covered shaded area for clients. The backyard is fenced. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There are no bodies of water. Continue on LIC809-C GARAGE: The attached garage is currently being used for storage. The team observe the garage locked and inaccessible to residents in care. In addition, the team observed laundry room is located in the garage. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. In addition to the Pre-Licensing inspection, a Component III power point presentation was conducted with the Administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator.the state’s words, verbatim · CDSS document, Apr 19, 2024