A New Life Board and Care

Type of visit: Required - 1 Year

At 11:15 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Licensee Diana Karapetyan and LPA explained the reason for the visit. Physical tour was conducted with the Licensee and LPA observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. At 11:20 AM, LPA observed adequate supplies of perishable and 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 cabinet and inaccessible to residents. Fire Extinguisher was last purchased on 09/03/2024. Medication: LPA observed centrally stored medication to be locked and in accessible to residents in care in a cabinet in the dinning room. Staff and residents files/records are kept in the facility office in a locked cabinet. BEDROOMS: There are five (4) bedrooms designated for residents use. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. LPA observed that one of the exits in bedroom #4 was blocked by a chest drawer and a chair. Facility has a bedroom designated for staff use only. BATHROOMS: At 11 26 AM, LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap; and paper towels. LPA observed appropriate grab bar and had non-skid mat. Hot water temperature measured at one of the bathrooms at 127.8°F. Continue on LIC809-C COMMON AREAS: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. During the visit LPA observed that one of emergency exit being blocked by a chair. LAUNDRY ROOM: The laundry room is located outside by bedroom #1 and LPA observed combination lock on the door. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. SURROUNDING GROUNDS: The back of the facility has sufficient yard space. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. There are no bodies of water. The garage is attached and currently being used for storage and LPA observed to be locked and inaccessible to resident sin care. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 11:35 AM, they were tested and observed to be operational. Between 12:00 PM to 2:30 PM, LPA reviewed records of six (6) residents and two (2) staff. Residents and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. Deficiencies cited during today’s visit. Appeal rights explained. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Aug 11, 2025

Type of visit: Required - 1 Year

At 1:45 PM Licensing Program Analysts (LPAs), Huma Rahimi and Leslie Ngo-Castaneda, conducted an unannounced annual inspection at the facility mentioned above. LPAs met with the staff, Marine Abrahamyan and the Administrator Gurgen Karapetyan, Administrator, arrived shortly after. LPAs explained the reason for the visit. Physical tour was conducted with the Administrator and LPAs observed the following: KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. At 1:50 PM, LPAs observed adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). LPAs observed a scissor accessible to residents in care in the kitchen on the counter top by the sink. All other knives and sharps are observed to be locked in a kitchen cabinet and inaccessible to residents. Fire Extinguisher was last purchased on 09/03/2024. BEDROOMS: There are five (4) bedrooms designated for residents use. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space and have sufficient lighting. Auditory alarms were tested and observed to be operational. Facility a bedroom designated for staff use only. LPAs observed medication bottle in the staff room unlocked and accessible to residents in care. Additionally, LPAs observed medications in bedroom # five (5) in resident's position. BATHROOMS: At 2:10 PM LPAs observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap; and paper towels. LPAs observed appropriate grab bar and had non-skid mat. LPAs observed medications in bathroom # 1 which is attached to bedroom number one (1). Continue on LIC809-C COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The living room and dining area appeared clean and were properly furnished. All exits were free of obstruction or hazards. MEDICATION ROOM: The medication and facility staff/resident files will be kept in a locked cabinet located kitchen cabinet. However, LPAs observed medications (Advil and Alcohol First Aid Antiseptic) accessible to residents in care in bedroom # 5. Additionally, the pantry in the hall was also observed unlocked with medications. LAUNDRY ROOM: The laundry room is located outside by bedroom #1 and LPAs observed combination lock on the door. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision. SURROUNDING GROUNDS: The back of the facility has sufficient yard space. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. The backyard is fenced. LPAs discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. The garage is attached and currently being used for storage and LPAs observed it unlocked with paint and other tools accessible to residents in care. SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 2:15 PM, they were tested and observed to be operational. Between 2:30 PM to 3:30 PM, LPAs reviewed records of four (4) residents and two (2) staff. Residents and staff records appeared to be complete and updated. Administrative: LPAs collected Certificate of Liability Insurance, and LIC500. A deficiency is cited during today’s visit. Appeal rights explained. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Sep 3, 2024

Allegation investigated: Facility is using kitchen equipment in poor repair. Facility staff/or Administrator is recording private conversations.

At 9:00am, Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM) Nichelle Gillyard conducted an unannounced complaint visit. LPA and LPM met with Gurgen Karapetyan, Administrator and discussed the reason for the visit. During course of the investigation, interviews and record review were made. At 9:05am, LPA and LPM requested resident and staff roster. At 9:10am, LPA and LPM requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Staff Training, relevant to the investigation. At approximately 9:15am, LPA and LPM conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:00am – 11:00am, LPA and LPM interviewed the Administrator, two (2) staff, and three (3) residents out of five (5) residents who were able to communicate. Continue on LIC9099-C Substantiated Allegation: Facility is using kitchen equipment in poor repair. It was alleged that the facility is using a burned-out microwave to heat food, and this is health hazard. To investigate this allegation LPM and LPA tested the microwave in the kitchen and observed it is operational. However, it was also observed that the inside coating is rusted and chipping away. LPM and LPA conducted a web review regarding the issue and per products.geappliances.com states that if the coating is flaking or peeling to discontinue the use of the microwave and replace it. Based on the information gathered and observation, this allegation is Substantiated at this time. Allegation: Facility staff/ or administrator is recording private conversations. It was alleged that the facility has cameras and are recording conversations. To investigate this allegation, LPM and LPA conducted an interview with the Administrator and the Designee and both confirmed that the facility has video surveillance equipment that is capturing audio conversation. This is a personal rights violation. LPM and LPA also requested to provide a footage of a current audio recording and confirmed the above allegation. Based on an observation and information gathered this allegation is deemed Substantiated at this time. Deficiencies issued per Title 22. Exit interview conducted appeal rights explained and copy of this report provided to the Administrator. Allegation: Staff not following medications procedures. It was alleged that the facility staff are touching medications with their hands. To investigate this allegation, LPM and LPA conducted an interview with the S1 and S2 and were informed that before pouring the medications in residents cups, they wear gloves and never touch the pill. S1 also informed LPM and LPA that all staff have taken medication training and are well aware on how to handle residents’ medication. Moreover, LPM and LPA requested S1 to demonstrate how the medications are being dispensed and observed that staff properly following medications procedures. LPA also reviewed and collected S1's and S2's current medication training. Based on interviews and observation this allegation is deemed Unsubstantiated at this time. Allegation: Staff not providing hygiene products. It was alleged that R1’s family member had to provide gloves and diapers for R1 while in care. To investigate this allegation, LPM and LPA conducted review of R1’s Admission Agreement and observed that on page 3, R1/family declined optional services to be provided by the facility, which means that R1/family will purchase/provide hygiene products upon request. Interview with the Administrator confirmed that R1’s family agreed to provide gloves and diapers upon request. However, per staff interview, should R1 run out of incontinent supplies, the facility maintains a supply and will provide r=to R1 and any other resident in need. Moreover, it was alleged that the bathrooms had no toilet papers or paper towels. During the walk through LPM and LPA observed two (2) out of two (2) bathrooms fully stocked with toilet paper and paper towels. Based on observation and information gathered, this allegation is deemed Unsubstantiated at this time. Allegation: Insufficient staffing. To investigate this allegation, LPM and LPA requested LIC500 (Personnel Report) and observed that the facility had seven (7) staff members registered to work. Interview with the Administrator revealed that the facility has enough staff to cover for each shift and all individuals listed on LIC500 are associated to this facility and still currently scheduled to work at the facility. Moreover, LPM and LPA conducted interviews with three (3) residents and all residents interviewed expressed no concerns regarding this allegation. Upon arrival LPM and LPA observed two (2) staff on duty, meeting residents needs. Therefore, based on interviews and record reviews this allegation is deemed Unsubstantiated at this time. Continue on LIC9099-C Allegation: Facility screens in poor repair. It was alleged that the window screen are in poor repair. To investigate this allegation, at 09:00am LPM and LPA conducted a physical plant tour of the entire facility: four (4) bedrooms, living room, dining room and two (2) bathrooms and checked all window screens. LPM and LPA observed that all window screens were properly installed and in good repair. Based on LPMs’ and LPAs’ observation this allegation is deemed Unsubstantiated at this time Allegation: Administrator's certificate expired. To investigate this allegation, at 11:00am, LPA conducted review of “Active Certification List” (updated on 06/05/24) and observed that the Administrator, Gurgen Karapetyan, received his most recent certificate effective 03/09/23 and will be expiring on 03/08/25. The facility designee/Administrator backup, Diana Karapetyan’s certificate expired on March 5th, 2024 and the renewal was submitted in January 2024, however, the actual certificate is still pending. Based on record review this allegation is deemed Unsubstantiated at this time. Exit interview conducted and copy of this report is signed and delivered.the state’s words, verbatim · CDSS document, Jun 12, 2024 · control 31-AS-20240604095416

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(29) · Plan of correction due date: Jun 19, 2024

General Food Service Requirements: (b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. This requirement is not met as evidenced by: Based on LPA and LPM's observation, licensee did not comply with the section cited above by having/using a microwave that has the inside coating rusted and chipping away. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 12, 2024

Plan of correction: Administrator agreed to replace the microwave and a copy of the reciept will be submitted to LPA

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(1) · Plan of correction due date: Jun 19, 2024

Additional Personal Rights of Residents in Privately Operated Facilities: (1) To have a reasonable level of personal privacy in accommodations... ... telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement is not met as evidenced by: Based on interviews and LPA and LPM's observation, the licensee did not comply with the section sited above by having a video surveillance equipment that is capturing audio conversation. This poses a potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Jun 12, 2024

Plan of correction: Administrator agreed to remove the audio until an approved waver is provided by the Community Care Licensing Division(CCLD). The Administrator shall submit a written statement that the audio component had been removed.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM) Nichelle Gillyard, conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20240606110421. LPA and LPM met with the Administrator and explained the reason for the visit. During the visit, LPA and LPM conducted a physical plan tour and the following was observed: Patio furniture was broken Living room exit door was blocked with arm chairs and floor light. Moreover, bedroom #4 exit door was blocked with an oxygen concentrator. Facility did not have a Oxygen in Use sign posted Bedroom # 2 door did not require to have a screen, however, the facility implemented a magnetic screen to be able to leave the door open and prevent flies from coming in. LPA and LPM observed the screen was ripped and in poor repair. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Jun 12, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 19, 2024

Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on LPA and LPM's observation, licensee did not comply with the section cited above by having a broken patio table in a backyard. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 12, 2024

Plan of correction: Administrator agreed to purchase a new patio furniture and submit a prove of receipt to LPA. Moreover, a magnetic screen in room #4 will be replaced and proof of picture will be submitted.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(d)(6) · Plan of correction due date: Jun 19, 2024

Personal Accommodations and Services: (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on LPA and LPM's observation, licensee did not comply with the section cited above by blocking the exit door in a living room and room #4. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 12, 2024

Plan of correction: During today's visit, the Administrator and staff cleared the passageways from the obstruction in the living room and bedroom

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87618(b)(3)(B) · Plan of correction due date: Jun 19, 2024

Oxygen Administration - Gas and Liquid: b) the licensee shall be responsible for the following: (3) Ensuring that the use of oxygen equipment meets the following requirements: (B) "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. Based on LPA and LPM's observation, licensee did not comply with the section cited above by not posting Oxygen in Use sign. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 12, 2024

Plan of correction: Administrator shall post an appropriate sign and submit proof of picture to LPA

Allegation investigated: Illegal eviction

At 12:15 PM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit. LPA met with Gurgen Karapetyan, Administrator and disclosed the reason for the visit. An initial visit was conducted on 04/26/24. At 09:45 AM, LPAs requested resident and staff roster. At 10:00 AM, LPAs requested copies of pertinent information which include, but not limited to Centrally Stored Medication and Destruction Record (CSMDR), Physician’s Report, Hospital Discharge Papers, Appraisal Needs and Services Plan, etc., relevant to the investigation. At approximately 10:10 AM, the team conducted a physical plant tour. Between 10:30 AM – 12:45 PM, the team conducted an interview with the Administrator, three (3) Staff, and three (3) out of five (5) residents who were able to communicate, and a family member of a resident. Continue on LIC 9099 Substantiated Illegal Eviction: It was alleged that the facility refused to take Resident #1 (R1) back after hospital discharge on 04/19/2024. During initial visit, LPAs were informed that the level of care for R1 changed; and therefore, the facility could not accept R1 back to the facility. However, upon LPA’s request, the Administrator could not provide sufficient document regarding R1’s changes in the level of care. Additionally, the investigation revealed the Administrator did not submit the Eviction letter to the Community Care Department nor served R1/family/representative with the 30-day Eviction notice. Based on interviews and record reviews this allegation is Substantiated at this time. Staff did not assist resident in a timely manner: In regards to the allegation, it was reported that on or around 04/17/2024, R1 required an assistance and was unable to press the call button due to the device being too far. To investigate this allegation, during initial visit, LPAs conducted an interview with the Administrator and were informed that the staff always makes sure to have emergency call buttons close to the residents’ bed, so they can call for an assistance. Interview with two (2) staff members revealed that as soon as the resident calls for help they respond immediately or within 10 minutes. In addition, both staff members informed LPAs that on 04/17/24, when R1 called for help the staff responded within five (5) to seven (7) minutes because both caregivers were busy helping other residents. Lastly, three (3) of the five (5) residents confirmed that the staff always provided assistance in a timely manner, and expressed no concern regarding the above allegation. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not assisting a resident in a timely manner, or staff not meeting a resident's diapering need. Therefore, the allegations are deemed Unsubstantiated at this time. Facility is in disrepair: It was alleged the facility’s alarm, bulb (light), and blinds are not in good repair. During the initial visit on 04/26/2024, the team was able to do a facility tour. The team did not observe any broken alarm, bulb (light), and blinds during the visit. LPAs inspected all alarms, lights, and blinds of the facility and found all of them in good repair and functional. Interviews with three (3) out of five (5) residents revealed that they had no issues with the alarm, lights, and broken blinds. Based on the inspection and observation, this allegation is Unsubstantiated. Staff did not order resident's medication refills in a timely manner: In regard to the above allegation: Staff failed to refill residents’ medication on a timely manner, LPA conducted an interview with R1’s family and was informed that R1’s medication for diabetes ran out and the facility failed to notify the family to refill and deliver a new bottle. In addition, during the initial visit, LPA conducted review of R1’s Centrally Stored Medications and Distraction Records (CSMDR) and observed that the bottle quantity was 200 tablets and prescribed to be taken twice a day. The start date of the medication was 01/26/2024. On 04/17/2024 the bottle had 34 pills left which was another sixteen (16) days’ supply. Lastly, all residents interviewed stated they had no issues receiving medication refills. Based on the record review and interviews conducted, there is insufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated. Continue on LIC 9099C Staff engaged in a verbal altercation in the presence of residents: It was alleged that the Staff and the family member of R1 were engaged in a verbal altercation in the presences of other residents. To investigate this allegation, LPA conducted an interview with the Administrator and two (2) staff members and was informed that on 04/13/2024, there was a verbal communication not an altercation between staff and R1’s family member. Moreover, interview with R2’s family member and three (3) out of five (5) resident who were able to communicate, confirmed that the conversation between S1 and R1’s family member escalated to a verbal altercation. However, all parties also confirmed that S1 did not raise their voice and tried to de-escalate the situation. R1’s family member, on the other hand, behaved in a very unprofessional manner and created a big scene for no reason. In addition, all witnesses informed LPA that they felt sorry for S1 for not being able to respond back to R1’s family member. Thus, based on interviews and the information gathered, this allegation is deemed Unsubstantiated at this time. Staff did not provide a safe and comfortable environment for residents: Regarding the allegation Staff failed to provide a safe and comfortable environment for residents, it was alleged that the facility has a tenant on the second floor of the facility, and they have a vicious dog always present in the backyard of the facility. During the time of initial visit, the LPAs did not observe any vicious dog nor any kind of dog present at the facility. During today’s visit, LPA also did not observe nor heard any dog bark. LPA conducted an interview with the Administrator that the tenant at the second floor does have a dog. However, the dog is always kept upstairs in a locked room and does not ever go to the backyard unleashed. Interview with three (3) out of five (5) residents confirmed the information. Based on interviews and observation this allegation is unsubstantiated at this time.the state’s words, verbatim · CDSS document, May 6, 2024 · control 31-AS-20240418101816

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(f) · Plan of correction due date: May 13, 2024

87224(f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above. LPA did not observe any proper documentation to evict R1.This poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, May 6, 2024

Plan of correction: Licensee agreed to submit a written statement about how eviction process will be conducted moving forward.

Allegation investigated: Resident fell due to neglect. Staff did not ensure that resident's incontinence needs were met.

This is an Amendment to the original report issued 01-29-2024 to clarify the findings. During today's visit 12-12-2023, before delivering the final report, LPA conducted a physical plant tour, to ensure the health and safety of the residents are protected and physical plant follows Title 22 Regulations. It was alleged that R1 fell due to neglect. The complainant’s concern is that on 06-29-2023 Resident #1(R1) was found lying on the floor and believes the resident fell. To investigate this allegation, LPA conducted an interview with staff, and residents. A records review was conducted. LIC 9099-C Unsubstantiated LPA requested and obtained Calls for Service with the local Emergency Service Agency during the time R1 was admitted. Upon review of the Calls for Service documents, there was no indication that R1 had fallen. R1 was having a medical incident during mealtime at the dining table, to prevent a fall, staff laid R1 on the floor. R1 did not fall, then 911 was called. It was founded that R1 had expired from natural causes. LPA was also able to interview the hospice nurse and obtain hospice records, there was no indication that R1 had fallen in the facility while in care. LPA obtained death certificate and it was indicated cause of death is ‘cardiorespiratory failure and hypertensive heart disease’. There was no evidence of a fall that contributed to the death on the Death Certificate. Administrator and two (2) staff all denied the allegation and reported that R1 never fell, allegation is false. Interview with residents stated that they had never witness any of the resident at the facility fall, residents stated that they always gets assistance from staff to be move around the facility. Based on inspection and interviews there is not sufficient evidence to support the allegation. Therefore, the allegation is unsubstantiated at this time. Exit interview conducted and copy of this report signed and delivered. It was alleged that R1 fell due to staff neglect and staff did not ensure the residents incontinence R1 were met. Upon interview of two (2) out of four (4) residents, they are happy and content with the facility, no complaints so far. An attempt interview was done for the other two (2) of the residents but was unavailable. LPA interviewed hospice nurse and was advised that the facility has always ensured the health and safety of the residents. LPA interviewed two (2) staff, licensee and administrator about the care given to the residents and stated that incontinence is changed every 2-3 hours or when residents soiled themselves. Hospice nurse witness that when residents asked for help, staff immediately attends to their needs. Administrator and two (2) staff all denied the allegation and reported that R1 incontinence care is false. Based on inspection and interviews there is no sufficient evidence to support the allegation. Therefore, the allegation is unsubstantiated at this time. No Deficiency cited during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Dec 12, 2023 · control 31-AS-20231114120121