Age Well Assisted Living Facility

Allegation investigated: Illegal Eviction

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent unannounced complaint visit to deliver findings. Due to the closure of the facility license effective 01/16/2026, today’s visit was conducted telephonically with former Licensee Sarkis Dovlatyan. On 09/02/2025, from 011:29 a.m. to 05:15 p.m., LPA Conway conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 11:28 a.m., LPA conducted a physical plant tour, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 09/04/2025, from 09:30 a.m. to 05:15 p.m. LPA Balisi conducted physical plant tour, interviewed staff and residents while onsite for a separate investigation. On 10/27/2025, from 10:00 a.m. to 03:00 p.m. LPA Balisi initiated a subsequent complaint visit. At approx. 10:02 a.m. LPA conducted physical plant tour, interviewed staff, residents and families / responsible parties and reviewed and obtained additional copies of pertinent documentation relevant to the investigation. On 10/21/2025, 10/27/2025, 02/04/2026, and 03/23/2026, LPA attempted to contact R1’s Social Worker however, these attempts were unsuccessful. Substantiated It was reported that there was an "illegal eviction" as It was alleged that Resident #1 (R1) was relocated to another facility without proper notice to the responsible party. Interviews and record review revealed that on 08/14/2025, R1 was admitted to this facility following discharge from a local hospital. The responsible party attempted to contact the facility but was unable to reach anyone until 08/16/2025, when they spoke with former Administrator Lala Soghomonyan. At that time, they were informed that R1 had been relocated to an unlicensed facility located at 41509 51st West Court, Lancaster, CA 93536. The responsible party was not provided prior notice of the relocation. On 08/21/2025, the responsible party removed R1 from the unlicensed facility. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred Therefore, the allegation of "Illegal eviction” has been Substantiated at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Due to the facility closure on 01/16/2026, a copy of this report and the appeals rights (LIC 9058 1/16) will be sent via email to Sarkis Dovlatyan and another certified copy vis USPS Sarkis Dovlatyan at their last known address. Former licensee / delegate should review, sign the report with a wet signature, and email the report back to CCLASCOWoodlandHillRO@dss.ca.gov or mail the report directly back to the LPA listed on the report at 21731 Ventura Blvd, Suite 250, Woodland Hills CA 91364 Continued from 9099 It was reported that "Resident inappropriately touched other resident" as It was alleged that Resident #1 (R1) inappropriately touched another resident. . Interviews conducted and records review reflected that on 09/04/2025 from 09:30 a.m. to 05:15 p.m , while on site for a separate investigation, LPA’s interview with four (4) residents reported that they did not recall R1 and have not witnessed any resident inappropriately touching another resident in care. Additionally, no residents expressed concerns about being inappropriately touched by another resident at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the 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 above allegation “Resident inappropriately touched other resident” is deemed Unsubstantiated at this time. Due to the facility closure on 01/16/2026, a copy of this report and the appeals rights (LIC 9058 1/16) will be sent via email to Sarkis Dovlatyan and another certified copy vis USPS Sarkis Dovlatyan at their last known address. Former licensee / delegate should review, sign the report with a wet signature, and email the report back to CCLASCOWoodlandHillRO@dss.ca.gov or mail the report directly back to the LPA listed on the report at 21731 Ventura Blvd, Suite 250, Woodland Hills CA 91364the state’s words, verbatim · CDSS document, Mar 30, 2026 · control 29-AS-20250829154344

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(c) · Plan of correction due date: Mar 30, 2026

The licensee shall, in addition to either serving the required thirty (30) days notice...and service three (3) days notice on the resident, notify or mail a copy of the notice to quit to the resident's responsible person. This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited when they issued a verbal eviction for R1 to be removed from the facility, which posed an immediate health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

Allegation investigated: Facility retained residents with prohibited health conditions Staff does ensure resident's medical needs are being met. Staff are not fingerprint cleared. Staff is administering insulin to resident. Staff are mismanaging resident's medications. Staff do not provide adequate food service to residents. Staff are not properly trained.

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent unannounced complaint visit to deliver findings. Due to the closure of the facility license effective 01/16/2026, today’s visit was conducted telephonically with former Licensee Sarkis Dovlatyan. On 10/07/2025, from 10:58 a.m. to 05:15 p.m., LPA’s Byrne and Urena conducted an initial 10-day complaint visit to investigate the allegations listed above. LPA’s conducted a physical plant tour, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 10/22/2025, from 09:30 a.m. – 2:00 p.m., LPA Balisi conducted a tour of the physical plant, interviewed staff, residents and reviewed and obtained copies of facility documents while on site for an unannounced Case Management visit. On 11/03/2025, from 10:00 a.m. to 02:30 p.m., LPAs Balisi and Arroyo conducted a physical plant tour, interviewed staff, residents and reviewed and obtained copies of facility documents while on site for an unannounced Plan of Correction visit. Substantiated Continued from 9099 On 12/11/2025, from 09:40 a.m. to 02:00 p.m. LPA Balisi conducted a physical plant tour, interviewed staff, residents and reviewed and obtained copies of facility documents while on site for an unannounced Case Management Visit. On 12/30/2025, from 09:30 a.m. to 01:00 p.m., LPA Balisi conducted a physical plant tour, interviewed staff, residents and reviewed and obtained copies of facility documents while on site for an unannounced Case Management Visit. On 01/05/2026, from 11:00 a.m. to 02:30 p.m., LPA Balisi conducted a physical plant tour, interviewed staff, residents and reviewed and obtained copies of facility documents while on site for an unannounced Case Management Visit. It was reported that "Facility retained residents with prohibited health conditions" and "Staff does not ensure resident's medical needs are being met as it was alleged that a resident was retained with a prohibited health condition and was not seen by home health for wound care. Interviews conducted and records review revealed Resident #1 (R1) and Resident #2 (R2) resided at the facility with prohibited health conditions. R1 had a stage 3 wound on their left ankle and R2 had a stage 4 wound on their hip. Administrator Lala Soghomonyan claimed residents were receiving home health services for wound care, however there was no documentation on site to review and confirm. LPA did not observe any exception requests on file for the (2) residents with prohibited health conditions to be accepted and retained in the facility. Interviews with residents reflected that no health care professional provided any services. Based on information gathered during the investigation, the department has sufficient evidence to confirm that multiple residents were retained with prohibited health care conditions and that facility staff did not meet the residents’ needs due to failure to follow up with any physician. Therefore, the above listed allegations "Facility retained residents with prohibited health conditions” and "Staff does not ensure resident's medical needs are being met” have been Substantiated at this time. It was reported that "Staff are not fingerprinted cleared" as it was alleged that staff do not have criminal record clearance. Interviews conducted and records reviewed revealed during LPA's Byrne and Urena's initial 10-day visit conducted on 10/07/2025, LPA's observed Staff #1 (S1) in the facility providing service to residents in care, however it was observed S1 was not associated to the facility. On 10/16/2025, while on site for a health and safety check visit at approx. 09:55 a.m. LPA reviewed caregiver background check on Guardian and observed Staff #2(S2) to not be associated to the facility. On 12/01/2025, while on site for a health and safety check visit at approx. 11:30 a.m. LPA reviewed caregiver background check on Guardian and observed association status of Staff #3 (S3) to be "In-process". Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred Therefore, the allegation of “Staff are not fingerprinted cleared" have been Substantiated at this time. Continued from 9099-C It was reported that " Staff is administering insulin to resident" as it was alleged that unqualified staff are administering insulin to R1. Interviews conducted and records review reflected that on 09/04/2025 from 09:30 a.m. to 05:15 p.m., while on site for a separate investigation, LPA’s Balisi and Arroyo observed Staff #4 (S4), who is not an Appropriately Skilled Professional (ASP), administer insulin to R1. LPA's records review of LIC 602 dated 08/19/2025 revealed R1 is Diabetic, unable to administer own medications and needs constant medical supervision. LPA's interview with S4 confirmed that S4 has administered the insulin to R1 at least once daily and they have not observed any nurse visit the facility to administer insulin to R1. Former administrator Lala Soghomonyan stated to LPA that a nurse came in every day to administer insulin to R1, however there were no records of visits on site to review to confirm the visits. LPA's interview with four (4) residents in care including R1, at the time of the complaint revealed that they do not recall a nurse coming to visit to administer insulin to R1. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Staff is administering insulin to resident” has been Substantiated at this time. It was reported that “Staff are mismanaging residents’ medications” and “Staff and are not properly trained” as it was alleged that residents are not receiving prescribed medications due to lack of staff training. Interviews and records reviewed during the investigation revealed that, during the initial 10-day visit on 10/07/2025 from 10:58 a.m. to 5:15 p.m., Resident #2 (R2) had not been administered simvastatin for approximately five (5) days. During the same visit, Resident #3 (R3) reported being aware of their prescribed medications and stated they must remind staff when medications are not provided. During a case management visit on 12/11/2025 from 9:40 a.m. to 2:00 p.m., it was observed that Resident #4 (R4)’s centrally stored medication list had not been updated for December 2025. Subsequent visits on 12/30/2025 from 9:30 a.m. to 1:00 p.m. and 01/05/2026 from 11:00 a.m. to 2:30 p.m. revealed that R5 was accessing the centrally stored medication cabinet on both dates. In an interview, R5 stated a preference to access and self-administer their medications, citing a lack of trust in staff to administer them correctly. Additionally, on 10/22/2025 during a case management visit from 9:30 a.m. to 2:00 p.m., Staff #5 (S5) did not have a complete personnel file available onsite for review. On 11/03/2025 during a case management visit from 10:00 a.m. to 2:30 p.m., records review revealed that S5 did not have valid first aid and CPR certification. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations of "Staff are mismanaging resident's medications" and “Staff are not properly trained” have been Substantiated at this time. Continued from 9099-C2 It was reported that "Staff do not provide adequate food service to residents" as It was alleged that the Administrator does not purchase food for residents. Interviews conducted and observations made by LPA during the course of the investigation reflected that during a separate investigation on 10/16/2025, it was revealed that Resident #5 (R5) provided their Electronic Benefit Transfer (EBT) card to the former Administrator for the purpose of purchasing food items. However, R6 reported that the requested items were not received. The EBT card was subsequently observed to have a zero balance. On 12/11/2025, during a physical plant tour conducted between 9:40 a.m. and 2:00 p.m., the LPA observed cucumbers with visible mold and cabbage that appeared significantly discolored and spoiled. On 12/30/2025, during a physical plant tour conducted between 9:30 a.m. and 1:00 p.m., the LPA observed that the facility did not maintain a sufficient supply of perishable food items in the refrigerator, including an absence of milk, eggs, and vegetables. Additionally, the LPA observed that the pantry door was secured with a lock, rendering non-perishable food items not readily accessible to residents in care. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred Therefore, the allegations of “Staff do not provide adequate food service to residents" has been Substantiated at this time. Due to the facility closure on 01/16/2026, a copy of this report and the appeals rights (LIC 9058 1/16) will be sent via email to Sarkis Dovlatyan and another certified copy vis USPS Sarkis Dovlatyan at their last known address. Former licensee / delegate should review, sign the report with a wet signature, and email the report back to CCLASCOWoodlandHillRO@dss.ca.gov or mail the report directly back to the LPA listed on the report at 21731 Ventura Blvd, Suite 250, Woodland Hills CA 91364the state’s words, verbatim · CDSS document, Mar 30, 2026 · control 29-AS-20251006194233

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Mar 30, 2026

Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:(1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on interviews / records review, licensee did not comply as R1and R2 were retained in the facility with prohibited health conditions, which posed an immediate health / safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Mar 30, 2026

All individuals subject to a criminal record review ...(b) shall prior to working... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department…This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as a criminal background fingerprint clearance was not conducted for S1, S2 and S3, which posed an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87629(b)(1) · Plan of correction due date: Mar 30, 2026

Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement was not met as evidenced by: Based on interviews, observations and records review, the licensee did not comply with the section cited above as S4 is not an appropriately skilled professional, but was observed administering insulin to R1, which posed an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Mar 30, 2026

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on interviews and observations the Licensee did not comply with the regulation cited above as R4 was observed accessing the centrally stored medication cabinet , which posed an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c)(1)(A) · Plan of correction due date: Mar 30, 2026

For staff who assist with personal activities of daily living, there shall be documentation of at least ten hours of initial training within the first four weeks of employment... specified in Section 87411(c)(2). This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as S5 did not have at least (10) hours of initial training , which posed a potential health and safety concern for residents in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Mar 30, 2026

Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: Based on observations, the Licensee did not comply with the regulation cited above as the Licensee failed to maintain a sufficient supply of foods such as milk, eggs, and produce, which posed a potential health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

Allegation investigated: Resident sustained unexplained injuries while in care. Staff left resident on floor for an extended period of time. Staff does not ensure resident's urinary drainage bag is being properly disposed Staff did not seek medical attention to resident. Staff does not ensure resident's bathing needs are being met.

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent unannounced complaint visit to deliver findings. Due to facility license revocation, facility was closed effective 01/16/2026. LPA contacted former Licensee Sarkis Dovlatyan, who stated they will review report via email / and mail. On 06/06/2025, from 09:30 a.m. to 12:00 p.m., LPA Balisi conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 09:50 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 07/10/2025, from 09:45 a.m. to 03:00 p.m. LPA conducted interviews with residents and staff while onsite for a separate investigation. On 09/04/2025, from 09:30 a.m. to 05:15 p.m. LPA conducted physical plant tour, interviewed staff and residents while onsite for a separate investigation. On 10/16/2025, from 09:30 a.m. to 03:30 p.m. LPA conducted physical plant tour, interviews with residents and staff while onsite for a separate investigation. Substantiated Continued from 9099 On 10/22/2025, LPA conducted physical plant tour, interviewed staff and resident with residents and staff while onsite for a separate investigation. On 10/31/2025, from 09:40 a.m. to 01:30 p.m. LPA conducted physical plant tour, interviewed staff and residents while on site for a separate investigation. On 01/16/2026, LPA received and reviewed hospital records for Resident #1 (R1). It was reported that “Resident sustained unexplained injuries while in care” as it was alleged that Resident #1 (R1) was admitted to a local hospital after bruising and/or red markings were observed on the body. Interviews and a review of available records indicated that on 06/09/2025, a family member visited R1 at the facility and found R1 on the floor. Facility staff were unable to explain the circumstances under which R1 was found on the floor or to identify what actions, if any, were taken following the incident. The family member contacted 911, and R1 was transported to and admitted to a local hospital. Interviews with the Administrator, Lala Soghomonyan, Staff #1 (S1), and the Owner, Sarkis Dovlatyan, indicated that they were not aware of the circumstances that led to R1 being found on the floor. Photographs reviewed at the regional office depicted multiple markings on R1’s arms and face that appeared consistent with bruising. At the time of the site visit, no records for R1 were available for review at the facility. Additionally, interviews and observations conducted during the investigation revealed that Resident #2 (R2) was admitted to a local hospital on 06/27/2025 due to changes in mental status. Upon hospital admission, R2 was assessed and documented as having two wounds: one on a lower extremity and one on the posterior thigh. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred Therefore, the allegation that “Resident sustained unexplained injuries while in care”” have been Substantiated at this time. It was reported that “Staff left resident on floor for an extended period of time” and “Staff did not seek medical attention to resident” as it was alleged that R1 was observed on the floor and staff did not call Emergency Medical Services (EMS). Interviews conducted and records review reflected that on 06/09/2025, a family member visited Resident #1 (R1) at the facility and found R1 on the floor. Facility staff were unable to explain how R1 fell or what actions, if any, were taken after R1 was observed on the floor. The family member contacted 911, and R1 was transported and admitted to a local hospital. Interviews with the Administrator, Lala Soghomonyan, S1, and the Owner, Sarkis Dovlatyan, revealed they did not have knowledge of the circumstances that resulted in R1 being found on the floor. Additionally, during the course of the investigation, it was revealed that Resident #3 (R3) also experienced a fall while in the facility and was not provided with first aid or care in a timely manner. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Continued from 9099-C Therefore, the allegation that “Staff left resident on floor for an extended period of time” and “Staff did not seek medical attention to resident” have been Substantiated at this time. It was reported that “Staff does not ensure resident's urinary drainage bag is being properly disposed” as it was alleged that R1’s urinary drainage bag was observed to be overflowing. Interviews conducted and records review reflected that on 06/07/2025, a family member visited R1 and observed R1’s urinary drainage bag to be overflowing. The family member changed the urinary drainage bag without staff assistance. Additionally, during the course of the investigation, it was revealed that Resident #4 (R4) also did not have their urinary drainage bag changed in a timely manner on multiple occasions. Interviews conducted two residents confirmed they had observed R4’s urinary drainage bag overflowing on multiple occasions. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff does not ensure resident's urinary drainage bag is being properly disposed” has been Substantiated at this time. It was reported that “Staff does not ensure resident's bathing needs are being met,” as it was alleged that R1 was not showered for at least four (4) days. Interviews conducted and records review reflected that on 06/09/2025, a family member visited R1 at the facility and observed R1 wearing the same clothing that R1 had been wearing during a prior visit on 06/07/2025. Facility staff were unable to state whether or when R1 had last received a shower. Interviews and observations conducted during the course of the investigation further revealed that R4 had not received a shower for an extended period while residing at the facility. Additionally, four residents interviewed during the investigation reported concerns regarding the availability of personal hygiene supplies, including soap, shampoo, and laundry detergent. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “Staff does not ensure resident's bathing needs are being met,” has been Substantiated at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Due to the facility closure on 01/16/2026, a copy of this report and the appeals rights (LIC 9058 1/16) will be sent via email to Sarkis Dovlatyan and another certified copy vis USPS Sarkis Dovlatyan at their last known address. Former licensee / delegate should review, sign the report with a wet signature, and email the report back to CCLASCOWoodlandHillRO@dss.ca.gov or mail the report directly back to the LPA listed on the report at 21731 Ventura Blvd, Suite 250, Woodland Hills CA 91364the state’s words, verbatim · CDSS document, Feb 11, 2026 · control 29-AS-20250611092348

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Feb 11, 2026

To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on interviews the licensee did not comply with the section cited above as R1 and R2 were observed with unexplained injuries, which posed an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Feb 11, 2026

The licensee shall immediately telephone 9-1-1 if an injury or other circumstance... apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as, S1 did not attempt to call 911 or the Administrator after R1 had a fall, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87623(b)(3) · Plan of correction due date: Feb 11, 2026

Ensuring that waste materials shall be disposed of as specified in Section 87303(f)(1). This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as, urinary drainage bags for R1 and R4 were not changed in a timely manner, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Feb 11, 2026

Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal...as specified in Section 87608, Postural Supports. This requirement was not met as evidence by: Based on interviews and observations, the licensee did not comply as R1 was observed multiple times without clothing and with toenails unkept. R1 / R2 were also not showered in a timely manner, which posed a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

Allegation investigated: Resident developed a pressure injury while in care Staff hit resident in care Staff do not ensure residents grooming needs are being provided Staff keep residents isolated in rooms without any interaction Staff do not ensure residents medications are dispensed as prescribed

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent unannounced complaint visit to deliver findings. Due to facility license revocation, facility was closed effective 01/16/2026. LPA attempted to contact former Licensee Sarkis Dovlatyan, but stated they were unavailble. Sarkis texted LPA confirming they will review report via email / and mail. On 06/06/2025, from 09:30 a.m. to 10:30 a.m., LPA Balisi conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 09:30 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 07/10/2025, from 09:45 a.m. to 03:00 p.m. LPA conducted interviews with residents and staff while onsite for a separate investigation. On 09/04/2025, from 09:30 a.m. to 05:15 p.m. LPA conducted a physical plant tour, interviewed staff and residents while onsite for a separate investigation. On 10/16/2025, from 09:30 a.m. to 03:30 p.m. LPA conducted a physical plant tour, interviewed residents and staff while onsite for a separate investigation. Substantiated Continued from 9099 On 10/31/2025, from 09:40 a.m. to 01:30 p.m. LPA conducted a physical plant tour, interviewed staff and residents while on site for a separate investigation. On 11/17/2025, LPA received and reviewed hospital records for Resident #1 (R1). It was reported that “Resident developed a pressure injury while in care” as it was alleged that Resident #1 (R1), sustained a pressure injury on their buttocks. Interviews conducted and records revealed R1 was admitted to a local hospital on 06/27/2025 for changes in mental status. Upon admission to the hospital, R1 was assessed for two (2) wounds; one located on a lower extremity and one located on the posterior thigh. Hospital records did not indicate any pressure injuries were observed on the buttocks area. A review of hospital records for R1 revealed there is documented history of pressure injuries in the same anatomical areas. Interviews with Staff #1(S1) and Assistant Administrator revealed they did not recall observing any wounds or bruising on R1 prior to the hospital admission. No records on site to indicate R1 was on hospice or home health. On 09/04/2025, during a subsequent complaint visit on a separate investigation, LPAs observed Resident #2 (R2) at the facility with a prohibited health condition. LPAs interview with administrator reflected that R2 did not have any Home Health (HH) services at that time of the visit. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Resident developed a pressure injury while in care” has been Substantiated at this time. It was reported that “Staff hit resident in care” and “Staff keep residents isolated in rooms without any interaction” as it was alleged that Staff #2 (S2) had hit R1 and on multiple occasions visitors observed the door to R1’s room to be closed and believed it to be closed for extended periods of time. No further details were provided to the reporting party. Interviews conducted over the course of the investigation reflected that S2 did in fact treat residents in an aggressive manner. S2 would yell, and did not allow residents to speak with each other, leave their bedrooms or eat outside. Interviews further reflected that S2 was also seen hitting a resident, however, no injuries were noted. Additionally Interviews further revealed four (4) residents in care revealed concerns regarding being confined to their rooms. Continued from 9099-C Three (3) of the four (4) residents reported that the hallway door separating the bedroom areas from the common area was observed to be closed and locked on multiple occasions. One (1) resident, who requires assistance transferring in and out of bed, reported not receiving the necessary support from staff. Another resident, who requires assistance with ambulating stated that staff did not provide assistance with safely ambulating throughout the facility. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff hit resident in care” and “Staff keep residents isolated in rooms without any interaction” have been Substantiated at this time. It was reported that “Staff do not ensure residents grooming needs are being provided” as it was alleged that R1 toenails were observed overgrown and unhygienic. On 06/06/2025, at approximately 9:45 a.m., during a physical plant inspection, the LPA observed that R1’s toenails appeared to be approximately 1 inch in length and unkept. LPA’s interview S1 revealed that the facility was awaiting a visit from a podiatrist to trim R1’s toenails. S1 further stated that R1 had not been assisted with showering since admission to the facility, as S1 had been informed that staff were not required to provide shower assistance because a home health nurse would be responsible for assisting R1. S1 stated they were unable to recall whether any home health agency had provided showering services to R1 at the time of the interview. At the time of the visit, no documentation was available on site to confirm that home health services had been arranged or provided. Interviews and observations conducted during the course of the investigation revealed that Resident 3 (R3) also had not received a shower for an extended period and had been observed to be unkept on multiple occasions while residing at the facility. Interview with R3 revealed they were awaiting services from a home health nurse. No records onsite indicated R3 were being seen by any home health agencies. Interviews with staff revealed they were not aware when home health services were to begin. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff do not ensure residents grooming needs are being provided” has been Substantiated at this time. It was reported that “Staff do not ensure residents medications are dispensed as prescribed” as it was alleged that R1 has not been receiving their medications as prescribed. At the time of the visit, no documentation was available on site to confirm medication was being administered as prescribed. Continued from 9099-C During the course of the investigation, it was revealed that Resident #4(R4) had been residing at the facility for approx. twelve (12) days and their insulin was never obtained, and Glucose testing was not conducted. R4’s file was not on site for review. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff do not ensure residents medications are dispensed as prescribed” has been Substantiated at this time. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Due to the facility closure on 01/16/2026, a copy of this report and the appeals rights (LIC 9058 1/16) will be sent via email to Sarkis Dovlatyan and another certified copy vis USPS Sarkis Dovlatyan at their last known address. Former licensee / delegate should review, sign the report with a wet signature, and email the report back to CCLASCOWoodlandHillRO@dss.ca.gov or mail the report directly back to the LPA listed on the report at 21731 Ventura Blvd, Suite 250, Woodland Hills CA 91364the state’s words, verbatim · CDSS document, Jan 28, 2026 · control 29-AS-20250701165718

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jan 28, 2026

Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:(1) Stage 3 and 4 pressure injuries. This requirement was not met as evidence by: Based on interviews / records review, licensee did not comply as , R1 was admitted into a local hospital with a prohibited health condition. Staff had no knowledge of any prohibited health conditions which posed an immediate health/ safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jan 28, 2026

To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with eh section cited as it was reported that residents were not treated with dignity and respect by S2 on multiple occasions, which posed an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Jan 28, 2026

To leave or depart the facility at any time and to not be locked into any room...such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited as it was reported that residents were confined to their room on multiple occasions which posed an immediate health, safety and person rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 28, 2026

The Licensee shall assist resident with self-administered medication as needed. This requirement was not met as evidenced by: Based on interviews and records review the licensee did not comply with the section cited as there were no records on site to review to confirm R1 received their medications as prescribed, which posed an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Jan 28, 2026

Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal...as specified in Section 87608, Postural Supports. This requirement was not met as evidence by: Based on interviews and observations, the licensee did not comply as R1 was observed multiple times without clothing and with toenails unkept. R1 / R2 were also not showered in a timely manner, which posed a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

Allegation investigated: Staff do not ensure that the facility remains free of odors Staff do not ensure resident's room is clean and sanitary Staff did not ensure resident was assisted with dressing Staff do not ensure resident's hygiene needs are being met Staff do not ensure resident's showering needs are being met Staff did not ensure resident received adequate first aid for injuries

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent unannounced complaint visit to deliver findings. Due to facility license revocation, facility was closed effective 01/16/2026. LPA attempted to contact former Licensee Sarkis Dovlatyan, but stated they were unavailble. Sarkis texted LPA confirming they will review report via email / and mail. On 06/06/2025, from 09:30 a.m. to 10:30 a.m., LPA Balisi conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 09:30 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 07/10/2025, from 09:45 a.m. to 03:00 p.m. LPA conducted interviews with residents and staff while onsite for a separate investigation. On 09/04/2025, from 09:30 a.m. to 12:30 p.m., LPA conducted a tour of the physical plant. LPA also interviewed staff and residents while onsite for a separate investigation. On 10/16/2025, from 09:30 a.m. to 03:30 p.m. LPA conducted a tour of the physical plant and also conducted interviews with residents and staff while onsite for a separate investigation. Substantiated Continued from 9099 On 10/31/2025, from 09:40 a.m. to 01:30 p.m. LPA conducted a physical plant tour, interviewed staff and residents while on site for a separate investigation. On 11/17/2025, LPA received and reviewed hospital records for Resident #1 (R1). It was reported that “staff do not ensure that the facility remains free of odors” and “staff do not ensure resident’s room is clean and sanitary” as it was alleged that R1’s room was observed to smell of urine like a “dog shelter” and that clothes were all over the floor. On 06/06/2025, at approximately 9:45 a.m., during a physical plant inspection, the LPA observed a urine odor coming from Resident #1’s (R1) room and observed unfolded clothing scattered on the bed. At approximately 9:50 a.m., the LPA observed Staff #1 (S1) mopping the hallways and common areas. During an interview, S1 stated that the floors were being mopped due to an odor originating from R1’s room. S1 further stated that R1 had thrown their clothing on the floor and that S1 had placed the clothing on the bed. Interviews and observations conducted during the course of the investigation revealed that flies were observed on multiple occasions in common areas and resident bedrooms due to trash cans not being emptied and food debris on counter tops. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff do not ensure that the facility remains free of odors” and “Staff do not ensure resident’s room is clean and sanitary” have been deemed Substantiated at this time. It was reported that “Staff do not ensure resident was assisted with dressing”, “Staff do not ensure resident’s hygiene needs are being met” and “Staff do not ensure resident’s showering needs are being met” as it was alleged that R1 was observed laying naked on top of bed and staff did not dress them in a timely manner, R1’s toenails were observed to be long and R1 was observed to appear to not have been showered for an extended period of time. On 06/06/2025, at approximately 9:45 a.m., during a physical plant inspection, the LPA observed a resident in bed without clothing, with a sheet covering the torso and waist area. During an interview, S1 reported that attempts were made on two occasions that morning to assist the R1 with dressing; however, the R1 removed the clothing each time. Staff further stated that the R1 was left alone with the intent to attempt dressing again later, but the R1 subsequently fell asleep. Continued from 9099-C S1 also stated they did not make any attempts to contact the Administrator for assistance. LPA also observed that R1’s toenails appeared to be approximately 1 inch in length and unkept. LPA’s interview S1 revealed that the facility was awaiting a visit from a podiatrist to trim R1’s toenails. S1 further stated that R1 had not been assisted with showering since admission to the facility, as S1 had been informed that staff were not required to provide shower assistance because a home health nurse would be responsible for assisting R1. S1 stated they were unable to recall whether any home health agency had provided showering or grooming services to R1 at the time of the interview. At the time of the visit, no documentation was available on site to confirm that home health services had been arranged or provided. Interviews and observations conducted during the course of the investigation revealed that Resident # 2 (R2) also had not received a shower for an extended period while residing at the facility. Additionally, four (4) residents interviewed during the investigation reported concerns regarding the availability of personal hygiene supplies, including soap, shampoo, and laundry detergent. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegations that “Staff do not ensure resident was assisted with dressing”, “Staff do not ensure resident’s hygiene needs are being met” and “Staff do not ensure resident’s showering needs are being met” have been Substantiated at this time. It was reported that “Staff did not ensure resident received adequate first aid for injuries” as it was alleged that R1 was observed with two (2) big wounds on hands. During LPAs visit on 06/06/2025, no wounds or visible markings on R1’s hands were observed. However, hospital records indicated that the R1 was admitted to a local hospital on 06/27/2025 for changes in mental status. Upon admission to the hospital, R1 was assessed for two (2) wounds; one located on a lower extremity and one located on the posterior thigh. A review of hospital records for R1 revealed there is documented history of wounds in the same anatomical areas. Interviews with S1 and Assistant Administrator revealed they did not recall observing any wounds or bruising on R1 prior to the hospital admission. No records on site to indicate R1 was on hospice or home health. Additionally, during the course of the investigation it was revealed that Resident #3 (R3) sustained a fall in the facility and was not provided with first aid or care in a timely manner. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not ensure resident received adequate first aid for injuries” have been Substantiated at this time. Continued from 9099-C Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Due to the facility closure on 01/16/2026, a copy of this report and the appeals rights (LIC 9058 1/16) will be sent via email to Sarkis Dovlatyan and another certified copy vis USPS Sarkis Dovlatyan at their last known address. Former licensee / delegate should review, sign the report with a wet signature, and email the report back to CCLASCOWoodlandHillRO@dss.ca.gov or mail the report directly back to the LPA listed on the report at 21731 Ventura Blvd, Suite 250, Woodland Hills CA 91364the state’s words, verbatim · CDSS document, Jan 28, 2026 · control 29-AS-20250602132841

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Jan 28, 2026

87465(g)The licensee shall immediately telephone 9-1-1 if an injury or other circumstance... apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited, as R1 was admitted into a local hospital with wounds on body. Staff had no knowledge of any wounds R1, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jan 28, 2026

Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:(1) Stage 3 and 4 pressure injuries. This requirement was not met as evidence by: Based on interviews and records review, the licensee did not comply as, R1 was admitted into a hospital with a prohibited health condition. Staff had no knowledge of any prohibited health conditions, which posed an immediate health/safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Jan 28, 2026

Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by: Based on interviews and observations, the Licensee did not comply in the section cited as the facility was observed to smell like urine throughout the facility , which posed a potential health, safety personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 28, 2026

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 was not met as evidenced by: Based on interviews and observations, the Licensee did not comply in the section cited as the facility was observed to smell like urine throughout the facility , which posed a potential health, safety personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Jan 28, 2026

Personal assistance and care as needed by the resident... bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement was not met as evidence by: Based on interviews and observations, the licensee did not comply as R1 was observed multiple times without clothing in the facility and toenails unkept. R1, R2 were not showered in a timely manner, which posed a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: No POC can be provided as this facility closed on 01/16/2026.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management – Other inspection at the facility today due to the closure of the licensed facility. Upon arrival LPA attempted to contact Licensee Sarkis Dovlatyan , but they stated they were unavailable for the visit. LPA contacted Acting Administrator Arshalouis Manoukian and explained the reason for the visit. Manoukian arrived at approx 10:30 a.m. On 12/31/2025, CDSS No. 6124053301 OAH No. was served to the License for the Revocation for the Facility license of Age Well Assisted Living Inc Facility # 197608986. As of 01/12/2026, the last (2) remaining residents were relocated to The Residences at Royal Bellingham Facility No. # 197608129. Today’s inspection is to ensure that there are no longer any elements of care or supervision of a licensed facility being provided at this location and to officially close the facility. At 10:35 a.m., LPA and Manoukian conducted a brief tour of the home. During the inspection, the LPA found no evidence to support that the home is being operated as a licensed facility. The license was forfeited at the time of the visit. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 16, 2026

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Brian Balisi conducted an unannounced Case Management - Other visit to follow up on the relocation of Resident #1 (R1) and Resident #2 (R2). LPA met with Acting Administrator Arshalouis Manoukian and explained the reason for the visit. LPA attempted to contact, Licensee Sarkis Dovlatyan via phone and text message, but was unsuccessful. During today’s visit, the LPAs conducted a tour of the facility inside and outside to ensure there were no immediate health or safety hazards. All utilities were observed to be on and functioning properly. The LPAs observed the kitchen and food supply and there is a sufficient amount of both perishable and non-perishable foods. According to Manoukian, R1 and R2 will be relocated to The Residences at Royal Bellingham Facility No. # 197608129. Manoukian stated they have been in constant contact with their Executive Director and will be present when they are relocated. Monoukian will update LPA as soon as they are relocated. At 11:02 a.m. Licensee text LPA and stated to have Manoukian sign for the report. No immediate health and safety concerns observed during the visit. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Jan 12, 2026

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Brian Balisi conducted a Case Management - Other visit to the facility. The purpose of the visit is to hand deliver a Decision and Order to Licensee facility Sarkis Dovlatyan. LPA arrived at the facility at approx 11:00 a.m. Upon arrival LPA's met with staff and explained the reason for the visit. LPA attempted to contact Licensee Sarkis Dovlatyan, but was unsuccessful. Licensee messaged LPA stating that they are out of town, but will have their Acting Administrator Arshalouis Manoukian meet LPA. LPA responded to Licensee's message requesting to speak over the phone. LPA, alongside Acting Administrator Arshalouis Manoukian reviewed and discussed the contents of the Decision and Order CDSS NO. 6124053301B and CDSS NO 6124053301C; served on 01/02/2026 for the Decertification / Non-Immediate Exclusion of Respondent Sarkis Dovlatyan. LPA and Acting Administrator Arshalouis Manoukian also reviewed and discussed the contents of CDSS No. 6124053301 OAH No. served on 12/31/2025, for Revocation for the Facility license of Age Well Assisted Living Inc Facility # 197608986 LPA reminded Manoukian that documents need to be shared with residents, residents responsible persons, and is required to be posted in the facility in a prominent place. LPA shared and discussed the Health and Safety Code §1569.38 Posting of licensing reports; disclosure to new residents with Manoukian. Manoukian acknowledged understanding of the requirement. During today's visit LPA conducted physical plant, interviewed staff and residents. The following was observed: At approx 11:37 a.m. LPA observed Resident #1 (R1) access their own medications from the locked medication cabinet. R1 then administered their own medication without assistance from Staff #1 (S1). At approximately 11:40 a.m., LPA observed R1 and S1 engaged in a verbal interaction during which both individuals were speaking loudly to one another. LPA instructed R1 and S1 to separate and calm down. An interview with R1 indicated that S1 constantly speaks to R1 in an aggressive tone. An interview with S1 indicated that S1 believed they were responding defensively due to R1 speaking to them in an unpleasant manner. LPA's interview with R1 and Resident #2 (R2), revealed both stated that on the evening of 01/03/2025, they were informed by an individual that R1 and R2 would need to relocate from the facility by Monday morning. R1 and R2 further stated they were not provided with a written or official notice to vacate the facility. Interview with Manoukian revealed that a representative from a tentative new facility arrived to the home and informed Manoukian they were there. Manoukian arrived approx 15 mins later and the representative was gone. A review of records by LPA found no eviction notice had been provided to the Department. During today’s visit, the LPAs conducted a tour of the facility inside and outside to ensure there were no immediate health or safety hazards. All utilities were observed to be on and functioning properly. The LPAs observed the kitchen and food supply and there is a sufficient amount of both perishable and non-perishable foods. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Civil penalties in the amount of $500 will be assess today for repeat violations. The Licensee rep was informed that failure to correct the deficiencies may result in additional civil penalties. At 11:45 a.m, 12:57 p.m. and 01:48 LPA attempted to contact Licensee Sarkis Dovlatyan by phone and text message, but was unsuccessful. Exit interview conducted with Manoukian, appeal rights discussed, and a copy of this report was provided. Manoukian was informed that they are cannot accept any new residents.the state’s words, verbatim · CDSS document, Jan 5, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jan 6, 2026

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on interviews and observations the Licensee did not comply with the regulation cited above as the R1 was observed accessing the centrally stored medication cabinet , which posed an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Jan 5, 2026

Plan of correction: Licensee representative spoke with R1 regarding their access to medication. Licensee also agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/06/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(1) · Plan of correction due date: Jan 6, 2026

To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews and observations the Licensee did not comply with the regulation cited above as S1 and R1 were involved in a verbal altercation which posed an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Jan 5, 2026

Plan of correction: Licensee representative spoke with R1 and S1 during the visit. Licensee rep also agreed to review review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/06/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Jan 12, 2026

The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement was not met as evidenced by: Based on interviews and records review the Licensee did not comply with the regulation cited above as R1 and R2 were told to vacate the facility by 01/05/2026, which posed an potential health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Jan 5, 2026

Plan of correction: Licensee agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/12/2026.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival at approx 09:30 a.m., LPA met with staff and explained the reason for the visit. LPA contacted Licensee Sarkis Dovlatyan who stated they can be availble later today. Administrator Arshalouis Manoukian arrived shortly after. At approx 9:45 a.m. LPA conducted physical plant, interviewed staff and residents the following was observed: At approx 09:50 a.m., LPA did not observed a sufficient supply of perishable foods stored in fridge. No milk, no eggs and no vegetables. Administrator stated the groceries will be delivered today. Leftover foods were observed to be properly sealed, and labeled. At approx 09:51 a.m LPA observed a lock on pantry door closet making non-perishable foods not readily accessible to residents in care. At approx 10:12am - LPA observed Resident #1 (R1) , unlock medication cabinet and administer own medications. LPA's interview with Staff #1 (S1), revealed that this past weekend, R1 has been refusing assistance with their medications. Between 09:45 a.m. 01:00 .m. LPA conducted interviews with R1, R2 and S1. These interviews revealed staff has been sleeping in the common area overnight since 12/28/2025. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Civil penalties in the amount of $500 will be assess today for repeat violations. The Licensee rep was informed that failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report was providedthe state’s words, verbatim · CDSS document, Dec 30, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Dec 31, 2025

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on interviews and observations the Licensee did not comply with the regulation cited above as the R1 was observed accessing the centrally stored medication cabinet , which posed an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: Licensee representative spoke with R1 regarding their access to medication. Licensee also agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 12/31/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(26) · Plan of correction due date: Jan 9, 2026

87555 (b)(26) - Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: Based on observations, the Licensee did not comply with the regulation cited above as the Licensee failed to maintain a sufficient supply of foods such as milk, eggs, and produce, which posed a potential health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: Licensee rep had groceries delivered today. Licensee rep also agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/09/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Jan 9, 2026

To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by: Based on observations, the Licensee did not comply with the regulation cited above as pantry for non-perishable foods was observed locked, which posed a potential health, safety and personal rights risks to persons in carethe state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: Licensee rep agreed to have locked removed today. Licensee rep also agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/09/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(a) · Plan of correction due date: Jan 9, 2026

The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility...This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as S1 has been sleeping on the couch in the living room which poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: Licensee rep agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/09/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Jan 9, 2026

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as S1 has been working since 12/28/2025 with no break which poses a potential health, safety, and personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: Licensee rep agreed to provide an updated LIC 500 then review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 01/09/2026.

Allegation investigated: Questionable Death

Licensing Program Analysts (LPA) Brian Balisi and Martha Arroyo conducted a subsequent complaint visit to deliver final findings for the allegation listed above. Upon arrival, LPAs met with staff and explained the reason for the visit. LPA's contacted Licensee Sarkis Dovlatyan who stated they will contact their Administrator Arshalouis Manoukian. Manoukian arrived shortly after. On 06/20/2025, the Department received a complaint alleging questionable death of Resident #1 (R1) due to staff neglect on 06/18/2025. It was reported that R1 was found deceased for a prolonged period of time. However, staff reported that R1 was checked approximately 10 minutes prior. On 06/23/2025 between approx. 10:10 a.m. – 04:40 p.m. LPA Martha Arroyo conducted an unannounced initial complaint inspection. During the visit, LPA met with licensee representative, Sarkis Dovlatyan. During the visit, between 10:15 a.m. and 2:00 p.m., LPA conducted a tour of the physical plant to ensure there was no immediate Health & Safety (H&S) concerns. Unfounded Additionally, LPA also conducted interviews with one staff and a resident. The case was referred to Community Care Licensing Division’s (CCLD) Investigations Branch (IB) and assigned to Investigator Michele Salant. On 09/15/2025, the RO obtained copies of Emergency Medical Service (EMS) reports along with 9-1-1 Audio Recordings and transcripts for the facility dating back to six (6) months. On 09/17/2025, Investigator Salant attempted to obtain reports from the Los Angeles County Medical Examiner’s Office for R1, however, was informed that there were no records for R1. On 09/22/2025, Investigator Salant conducted a visit to the facility and conducted interviews with residents and staff. On 09/24/2025, at approx. 10:00 a.m., Investigator Salant, attempted to contact Licensee Representative, Sarkis Dovlatyan, but was unsuccessful. Investigator left a voice mail requesting a call back in order to set an interview time. However, at approx. 10:30 p.m., Dovlatyan emailed Investigator Salant with a PDF attachment containing staff member roster, admissions record, medications list for R1 and Resident #2 (R2) along with Hospice records and Physician's report for R2. Dovlatyan also stated he will be out of town (for an undisclosed amount of time) and will not be able to meet Investigator Salant for an interview but stated Administrator Lala Soghomonyan would contact them to schedule a meeting. On 09/30/2025, Investigator Salant interviewed Administrator Lala Soghomonyan at Age Well Assisted Living Facility. Information gathered during the course of the investigation reflected that R1 was alive and relocated to a different facility. On 10/02/2025, Investigator conducted a visit to Dignity Health and observed R1 alive and well. It was revealed that facility on 06/18/2025, Los Angeles Fire Department (LAFD) arrived and found a deceased individual who was identified as R1 by the staff. However, based on information gathered facility staff disclosed the incorrect information to LAFD. Therefore, the above allegation, “Questionable Death” of R1 is deemed UNFOUNDED at this time. Deficiencies observed during the course of the investigation that is not related to the complaint will be cited on a separate Case Management – Deficiency.the state’s words, verbatim · CDSS document, Dec 19, 2025 · control 29-AS-20250620153333

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Martha Arroyo and Brian Balisi conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival, the LPAs met with staff and explained the reason for the visit. LPA Balisi contacted Licensee Sarkis Dovlatyan and informed him of the visit. The Facility Designee, Arshalouis Manoukian arrived at approximately 10:27 a.m. Entrance Interview. During today’s visit, the LPAs conducted a tour of the facility inside and outside to ensure there were no immediate health or safety hazards. The LPAs observed two residents sitting on the dining table, who reported they were doing well and were waiting for breakfast to be served. Residents did not report any concerns during today’s visit. All utilities were observed to be on and functioning properly. The LPAs observed the kitchen and food supply and there is a sufficient amount of both perishable and non-perishable foods. At approximately 10:45 a.m., the LPAs observed an unlocked cabinet with resident’s medication accessible to residents in care. The Facility Designee placed the medication in a locked cabinet during the inspection. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). The Facility Designee was informed that failure to correct the deficiencies may result in additional civil penalties. A civil penalty in the amount of $250 will be assessed today due to this being a repeat violation within 12 months. Exit interview conducted with Administrator, appeal rights discussed and copy of report provided.the state’s words, verbatim · CDSS document, Dec 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Dec 22, 2025

The following requirements shall apply to medications...Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on LPAs observation, the licensee did not comply with the section cited above as resident’s medication was observed inside an unlocked cabinet making it accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: The Facility Designee agreed to review regulation cited and submit a statement of understanding to CCL by COB 12/22/2025. A civil penalty in the amount of $250 will be assessed today due to this being a repeat violation within 12 months.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Brian Balisi and Martha Arroyo conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20250620153333). The purpose of the visit is to issue citations for deficiencies observed during the complaint investigation unrelated to the complaint. Upon arrival, LPAs met with staff and explained the reason for the visit. LPA's contacted Licensee Sarkis Dovlatyan who stated they will contact their Administrator Arshalouis Manoukian. Manoukian arrived shortly after. On 06/20/2025, the Department received a complaint alleging questionable death of Resident #1 (R1). The case was referred to Community Care Licensing Division’s (CCLD) Investigations Branch (IB) and assigned to Investigator Michele Salant. On 09/15/2025, the RO obtained copies of Emergency Medical Service (EMS) reports along with 9-1-1 audio recordings and transcripts for the facility dating back to six (6) months. A review of the EMS reports, 9-1-1 recordings and transcripts revealed two (2) additional questionable deaths, Resident # 2 (R2), Resident #3 (R3), that were not reported to the department. According to the EMS reports reviewed, upon paramedics’ arrival on 05/16/2025 at 9:58 a.m., R2 was noted to be unconscious, cold to touch, in lividity and Dead on Arrival (DOA). Per the facility staff, R2 was last seen approx. 14 hours prior. Staff observed R2 to be unresponsive and not breathing in the morning when attempting to change R2s diaper. Moreover, according to EMS, it was notated that the resident was found in supine position, laying in bed in a state of “rigor, as well as lividity.” On 05/30/2025 at 11:03 a.m., Paramedics arrived at the facility and observed R3 unresponsive, pale, DOA in obvious rigor and lividity. Staff noted that R3 was last seen approx. 5 hours ago. Furthermore, during the course of the complaint investigation it was revealed that on 06/18/2025, Los Angeles Fire Department (LAFD) arrived at the facility for a deceased individual, who was identified by staff as R1. However, the complaint investigation reflected that the deceased individual was in fact Resident #4 (R4) and staff provided LAFD with incorrect information. R1 was observed alive and well living at a different facility. Per EMS report, upon arrival R4 was already in a state of rigor and lividity. Based on paramedics’ assessment, the state of rigor and lividity indicates R4 had been deceased for more than a minimum of an hour. Flies were seen in the residents’ mouth and nose, and facility had bare minimum care equipment on site. Staff were unable to provide any information regarding the resident to emergency personnel and informed them that R4 was seen alive 10 minutes prior, which is contradictory to how R4 was discovered by EMS. Investigator Salant made several attempts on 09/30/2025, 10/02/2025, 10/03/2025 and 10/14/2025 to obtain facility records for all four (4) residents from facility administrator, Lala Soghomonyan. On 09/24/2025, Investigator Salant requested records from the licensee representative, Sarkis Dovlatyan, who provided hospice records dated with the same date they were requested even though the residents had been deceased prior to the requested date. Facility administrator also denied R4 was a resident at the facility. The Facility Administrator and licensee failed to maintain complete and accurate resident records, including care documentation, monitoring records, and medical records, for residents R2, R3, and R4. Hospice records for R2 were provided only after request and could not be verified as accurate or complete. The lack of required documentation prevented the Department from determining the care, supervision, and health-related services provided prior to the residents’ deaths. Additionally, the licensee failed to ensure sufficient and competent staff were present and adequately trained to meet residents’ needs. Staff failed to conduct routine welfare checks, failed to recognize changes in residents’ conditions, and provided inconsistent and contradictory statements regarding resident observations. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Civil penalties in the amount of $500 will be assess today for repeat violations. The Licensee was informed that failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report was providedthe state’s words, verbatim · CDSS document, Dec 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.312(a) · Plan of correction due date: Dec 22, 2025

§1569.312(a) Basic services requirements. Basic services shall at a minimum include:(a)Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as Facility staff did not provide sufficient care and supervision to R2, R3 and R4 which resulted in their death’s, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee will submit a plan how you will ensure appropriate care and supervision to residents. Submit to CCL via email by due COB 12/22/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87466 · Plan of correction due date: Dec 22, 2025

The licensee shall ensure that residents are regularly observed for changes in physical...brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as Facility staff did not provide sufficient observation to R2, R3 and R4, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee will submit a plan how you will ensure sufficient observations are conducted to residents in care then submit to CCL via email by 12/22/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87506(a) · Plan of correction due date: Dec 22, 2025

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 was not met as evidenced by: Based on interviews and records review the Licensee did not comply with the regulation cited above as the Licensee failed to maintain full and accurate resident records , which posed an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee agreed keep full facility files, review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 12/22/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR87207 · Plan of correction due date: Dec 22, 2025

No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidenced by: Based on interviews and records review the Licensee did not comply with the regulation cited above as the Licensee provided false information to LAFD, which posed an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee agreed to review section cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 12/22/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Dec 22, 2025

Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement was not met as evidenced by: Based on interviews and records review the Licensee did not comply with the regulation cited above as Death Reports were never provided to the RO for R2, R3 and R4, which posed an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 12/22/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87411(a) · Plan of correction due date: Dec 22, 2025

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...the facility require such additional staff for the provision of adequate services. This requirement was not met as evidenced by: Based on interviews and records review the Licensee did not comply with the regulation cited above as staff failed to observe residents’ condition, resulting in deaths occurring unnoticed, which poses an immediate health, safety and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Dec 19, 2025

Plan of correction: Licensee agreed to review regulation cited and provide a written plan to ensure future compliance then provide to LPA via email by COB 12/22/2025.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival at approx 10:40 a.m., LPA met with staff and explained the reason for the visit. Licensee was contacted and stated they can be present at the visit later in the day. The tentative new Administrator Arshalouis Manoukian arrived shortly after. At approx 09:50 a.m. LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of facility documents. LPA observed Accusation for License Revocation, Revocation / Forfeiture of Administrator Certificate, and Exclusion Action posted on the wall in the office area. At approx 09:51 a.m. LPA observed cucumbers with mold and Cabbage that appeared to be extremely brown. Administrator discarded produce right away. LPA observed a sufficient supply of non-perishable food properly stored at this time in the pantry. Common areas, restroom and resident bedrooms observed clean and odor free. Residents were interviewed. Interviews with residents revealed they have been provided with sufficient meals and snacks since the last inspection visit on 12/01/2025 and residents did not express any concerns at this time. Residents also stated they were aware of the accusation that was posted on 12/01/2025. During LPA Trevor Byrne's Pre-Licensing Visit on 11/20/2025 for Age Well Assisted Living #195850516, the following was notated: LPA did not observe an auditory alarm installed on the front gate as required by 87705(d). LPA did not observe the personal rights of residents posted in the facility as required by 87468(d). LPA did not observe the required healthcare practitioners notice posted in the facility as required by 87605(c). Continued from 809. LPA was also unable to review the facility’s updated emergency disaster plan to review the corrections that were identified in the previous pre-licensing inspection. Today LPA observed the following: LPA observed auditory alarm to be functioning when Administrator opened and closed front entry gate. LPA observed personal rights form to be posted by entry way. LPA observed an updated emergency disaster plan kept in a facility file. Administrator posted plan by entry way. LPA observed new camera's installed, but were not functioning at this time. At approx 10:30 a.m. LPA did not observe the required healthcare practitioners notice posted in the facility as required by 87605(c). At approx 11:30 a.m. LPA conducted medication review for Resident #1 (R1). Medication review revealed R1's Centrally stored medication list has not been updated for December 2025. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). The Licensee was informed that failure to correct the deficiencies may result in additional civil penalties. Licensee was contacted and stated they were not able to be onsite at this time. Exit interview conducted with Administrator, appeal rights discussed and copy of report provided.the state’s words, verbatim · CDSS document, Dec 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(6) · Plan of correction due date: Dec 12, 2025

The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes...: This requirement was not met as evidenced by: Based on records review, Centrally stored medication list for R1 (R1) had not been updated for December 2025, which is an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: Administrator agreed to update Centrally stored Medication list and review section cited then provide LPA with a written plan to ensure future compliance by COB 12/12/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87605(c) · Plan of correction due date: Dec 19, 2025

Licensees who employ or permit health care practitioners... health care practitioners to disclose their name and license status on a name tag in at least 18-point type while working in this facility.” This requirement was not met as evidenced by: Based on observations, the LPA did not observed required healthcare practitioners notice posted in the facility, which is a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: Administrator agreed to post statement by entryway. They also agreed to review section cited and provide LPA a statement of understanding by POC 12/19/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Dec 19, 2025

All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement was not met as evidenced by: Based on observations, LPA observed cucumbers to have mold and cabbage to be browned which is a potential health, safety or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Dec 11, 2025

Plan of correction: Administrator discarded produce right away and agree to review section cited and provide LPA a written plan to ensure future compliance by COB 12/19/2025.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival at approx 10:45 a.m., LPA met with staff and explained the reason for the visit. Licensee was contacted and stated they will be at the facility soon. On 11/13/2025, Accusation for License Revocation, Revocation / Forfeiture of Administrator Certificate, and Exclusion Action was sent to Licensee of Age Well Assisted Living Facility. On 11/18/2025, Zabel Chochian conducted a case management - other visit to ensure health and safety of residents in care. During that visit, LPA Chocian attempted to go over the accusation, however Licensee Sarkis Dolatyan stated they wanted to review with their attorney. LPA reminded Mr. Dovlatyan that the Accusation needs to be shared with residents, residents responsible persons, and is required to be posted in the facility in a prominent place. LPA shared and discussed the Health and Safety Code §1569.38 Posting of licensing reports; disclosure to new residents with Mr. Dovlatyan. Mr. Dovlatyan acknowledged understanding of the requirement. Per Health and Safety Code §1569.38(g), A licensee who fails to comply with the requirements of subdivision (b) or (c) shall be liable for civil penalties in the amount of one hundred dollars ($100) for each day of the failure to provide notification as required in this section. The total civil penalty for each day shall not exceed one hundred dollars ($100) regardless of the number of notices that the licensee fails to send that day. The total civil penalty for a continuous violation of subdivision (b) or (c) shall not exceed five thousand dollars ($5,000). Today at approx 11:00 a.m. did not observe accusation posted in a prominent place. Between 11:00 a.m. - 3:00 p.m. LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of facility documents. LPA observed a sufficient supply of perishable and non-perishable food properly stored at this time. LPA and staff inspected produce that was stored in fridge drawers. LPA observed produce to appear fresh and free of any signs of mold at this time. Interviews with residents revealed they have been provided with sufficient meals, snack and service. On 11/25/2025, newly appointed Administrator Nailah Tatum sent an email to LPA stating that they no longer work with Age Well Assisted Living. Today at approx 09:30 a.m. LPA contacted Tatum who confirmed they will not be moving forward with Age Well. LPA spoke with Licensee who stated Arshaluis "Lucy" Manoukyan will be the new Administrator going forward. On 11/28/2025, The Regional office received information that the heater in the facility stopped working and residents were going to be relocated to 8123 Paso Robles Ave , (All Star Living Inc #195850586). LPA's interview with residents revealed they were asked if they wanted to relocate , but they did not want to relocate from this home. Space heater was provided to Resident #1(R1). Resident #2(R2) stated they did not want a space heater and that they preferred it to be cold. Both R1 and R2 did not express any concerns for temperature of facility at this time. During the visit, LPA observed the facility to be at a comfortable temperature. At approx. 11:30 a.m. LPA reviewed caregiver background check on Guardian and observed status of Staff #1 (S1) to be "In-process". Licensee contacted another caregiver to relieve S1. Staff #2 (S2) arrived at approx 01:00 p.m. LPA's interview with S1 and residents in care revealed S1 arrived to the facility this morning. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Civil penalties in the amount of $1,400 will be assess today for failure to post accusation in a prominent place and repeat violations. The Licensee was informed that failure to correct the deficiencies may result in additional civil penalties. During the visit, the LPA did not observe any immediate health or safety concerns. Exit interview conducted with licensee, appeal rights discussed and copy of report provided.the state’s words, verbatim · CDSS document, Dec 1, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Dec 2, 2025

Criminal Record Clearance: All individuals subject to a criminal record review ...(b) shall prior to working... in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department…This requirement was not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as S1 was not associated , which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 1, 2025

Plan of correction: S1 exited the facility during the visit and was relieved by S2. Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 12/02/2025.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.38(g) · Plan of correction due date: Dec 2, 2025

A licensee who fails to comply with the requirements of subdivision (b) or (c) shall be liable for civil penalties in the amount of one hundred dollars ($100) for each day... (b) or (c) shall not exceed five thousand dollars ($5,000). This requirement was not met as evidenced by: Based on observations, the licensee did not comply with the section cited above as LPA did not observe accusations posted in a prominent place, which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 1, 2025

Plan of correction: Licensee posted Accusation letter during the visit. Licensee also agreed to review section cited and submit a statement of understanding along with a written plan on how they will ensure future compliance then send to LPA via email by COB 12/02/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Dec 2, 2025

All facilities shall have a qualified and currently certified administrator... facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Based on interviews and records review the licensee did not comply with the section cited above as facility did not have an active administrator, which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 1, 2025

Plan of correction: Licensee agreed to review section cited and email LPA with completed documents for new Administrator by COB 12/02/2025.

Allegation investigated: Staff did not afford a resident with dignity and respect by misrepresenting the availability of cleaning supplies. There is insufficent cleaning supplies to ensure an adequate supply of clean dishes.

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 10:01 AM. LPA met with facility Licensee Representative Sarkis Dovlatyan entrance interview conducted and the reason for the visit was explained. During today’s visit LPA conducted a physical plant tour, and conducted interviews with the Licensee Representative, one (1) staff, and two (2) residents between approximately 12:15 PM and 01:40 PM. Continued on LIC-9099C Unsubstantiated The allegation of “There is insufficient cleaning supplies to ensure an adequate supply of clean dishes.” alleges that the facility did not maintain an adequate supply of dish soap to ensure clean dishes and utensils for resident use. During the physical plant tour LPA observed a bottle of dish soap located next to the kitchen sink. LPA observed a small amount of soap left in the bottle which appeared to be less than approximately one (1) centimeter of soap remaining. LPA observed the cleaning supplies under the kitchen sink and in the laundry room. LPA did not observe additional dish soap available at the facility. LPA observed one (1) side of the kitchen sink to contain dishes and utensils. Staff #1 (S1) informed LPA that the dishes had been rinsed but had not yet been washed. LPA observed the cabinets in the kitchen. LPA observed an adequate number of clean dishes including plates and bowls for more than one (1) day. LPA observed the utensils drawer to contain three (3) spoons, two (2) forks, and three (3) butter knives. LPA interviewed S1 who informed LPA that they notified the Licensee Representative of the low dish soap and other cleaning supplies on Tuesday 11/18/2025. LPA interviewed the Licensee Representative who stated that they were aware that the facility was running low on dish soap and cleaning supplies. Licensee Representative stated that they are informed by staff when supplies are running low and will place an order once they are informed. Licensee Representative stated that they do not check on supplies themselves. Licensee Representative stated that they had placed an order for delivery of dish soap, laundry detergent, and bleach to restock facility supplies. Licensee Representative provided LPA a photo of their amazon delivery orders showing three (3) bottles of Ajax liquid dish soap arriving tomorrow (11/21/2025). LPA observed this order to be placed on today’s date (11/20/2025). Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “There is insufficient cleaning supplies to ensure an adequate supply of clean dishes.” Therefore, the allegation is deemed Unsubstantiated at this time. Continued on LIC 9099C. The allegation of “Staff did not afford a resident with dignity and respect by misrepresenting the availability of cleaning supplies.” alleges that facility staff told a resident that there was additional dish soap stored at the facility in the washer/dryer room and not to worry about the low dish soap supply. One (1) resident interviewed, resident #1 (R1), stated that S1 assured them that there was extra soap available at the facility in the washer/dryer room. LPA interviewed S1 who denied telling facility residents that there was additional dish soap in the chemical storage. S1 stated that they informed residents that they would have to check if there was additional soap and if not, they would inform the owners to procure more. S1 stated that they informed residents that they would handle the issue and for the residents not to worry as this was an issue for them and the owner to handle. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not afford a resident with dignity and respect by misrepresenting the availability of cleaning supplies.” Therefore, the allegation is deemed Unsubstantiated at this time. The Licensee Representative was unable to come to the facility at the time this report was issued but has allowed S1 to receive and sign this report on their behalf. A copy of the report was printed, appeal rights were provided, and exit interview was conducted with S1.the state’s words, verbatim · CDSS document, Nov 20, 2025 · control 29-AS-20251120121920

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival LPA met with staff and explained the reason for the visit. Staff contacted Licensee representative, Sarkis Dovlatyan. During todays visit, LPA conducted a physical plant tour with staff at approximately 12:05 p.m.. LPA observed a sufficient supply of perishable and non-perishable food properly stored at the time of the visit. LPA observed fresh produce, eggs, sausages, deli meat, chicken and condiments in the fridge; frozen poultry, fish sticks, crab, frozen vegetables and other frozen goods observed in the freezer. LPA also observed dried and canned food items in the storage. Common areas, restroom and resident bedrooms observed clean and odor free. Residents were interviewed from approximately 12:15 and 12:30 p.m. Interviews with residents revealed they have been provided with sufficient meals and snacks since the last inspection visit on 11/12/2025 and residents did not express any concerns at this time. At approximately 12:45, Mr. Dolatyan called the facility and spoke with LPA. Reason for the visit was explained. Mr. Dovlatyan explained that he is unable to come to the facility and the Administrator Nailah Tatum is currently in class and wont be available until after 5 p.m. LPA contacted the Administrator and left a voicemail message.LPA spoke with Mr. Dovlatyan by telephone again at approximately 1:30 p.m. LPA asked Mr. Dovlatyan if he received the Accusation filed and dated on 11/13/2025. Mr. Dovlatyan stated that he received a great amount of documents few days ago but has not yet reviewed the documents. LPA explained the Accusation document and Mr. Dovlatyan agreed to go over the Accusation over the phone. As LPA began reading the Accusation for License Revocation, Revocation/Forfeiture of Administrator Certificate, and Exclusion Action, Mr. Dovlatyan stated that he does not want to go over this document over the phone. He stated that he will review it with his attorney and will contact the case LPA if he has any questions. LPA reminded Mr. Dovlatyan that the Accusation needs to be shared with residents, residents responsible persons, and is required to be posted in the facility in a prominent place. LPA shared and discussed the Health and Safety Code §1569.38 Posting of licensing reports; disclosure to new residents with Mr. Dovlatyan. Mr. Dovlatyan acknowledged understanding of the requirement. During today's visit, the LPA did not observe any immediate health or safety concerns. Exit interview conducted with Mr. Dovlatyan. Mr. Dovlatyan authorized staff to sign for today's report. A copy of this report and the previous visit report dated 11/12/2025 was provided.the state’s words, verbatim · CDSS document, Nov 18, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 10:15 AM to conduct an unannounced Case Management – Deficiencies visit at the facility today. LPA met with facility licensee representative Sarkis Dovlatyan entrance interview conducted and the reason for the visit was explained. During today’s visit between 10:15 AM and 01:00 PM LPA conducted a physical plant tour, interviewed Staff #1 (S1), the licensee representative, and one (1) resident. During the physical plant tour LPA observed the PUB 475 poster to be smaller than the required 20” x 26” size. LPA did not observe the personal rights or nondiscrimination notice to be posted in the facility. LPA did not observe a visible notice posted in a prominent location that states, “Section 680 of the Business and Professions Code requires health care practitioners to disclose their name and license status on a name tag in at least 18-point type while working in this facility.” LPA informed the licensee representative who stated that the personal rights, nondiscrimination notice, and complaint information were removed from the wall but were still present at the facility. The licensee representative agreed to post the required items along with an appropriately sized copy of the PUB 475 poster in the facility. During today’s visit LPA had a conversation with the licensee representative and S1, LPA informed them that on 10/20/2025 Lala Soghomonyan, was served with an “Order to Individual for Immediate Exclusion from All Facilities” notice. LPA informed S1 and the licensee representative that Lala Soghomonyan may not be present at the licensed facility at any time. S1 and licensee representative expressed understanding and confirmed that Lala Soghomonyan would not be present at any time on the facility premises. Pursuant to Title 22, California Code of Regulations, the following deficiencies were cited (refer to LIC809-D). Exit interview conducted and copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Nov 12, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87605(c) · Plan of correction due date: Nov 26, 2025

87605 Health and Safety Protection (c) ...shall post... “Section 680 of the Business and Professions Code requires...practitioners to disclose their name and license status on a name tag in at least 18-point type while working in this facility.” This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above as home health and other healthcare providers provide services to residents and the required posting was not present at the facility which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2025

Plan of correction: The licensee representative agreed to post the required information in a prominent location no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468(d) · Plan of correction due date: Nov 26, 2025

87468 Personal Rights (d) Licensees shall post the personal rights, nondiscrimination notice, and complaint information specified above in English, and, in any other language... the residents can only read... This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above as the personal rights and nondiscrimination notice was not posted at the facility which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2025

Plan of correction: The licensee representative agreed to post the required information in a prominent location no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468(c)(2)(A) · Plan of correction due date: Nov 26, 2025

87468 Personal Rights (c) Licensees shall prominently post... (2) ... shall be posted as follows: (A) ...(RCFE) Complaint Poster (PUB 475)...The poster that is posted shall be 20" x 26" in size... This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above as the PUB 475 poster posted at the facility was smaller than the required size which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2025

Plan of correction: The licensee representative agreed to post the required posting in an appropriate size in the entryway of the facility no later than POC due date.

Type of visit: POC

Licensing Program Analyst (LPA) Brian Balisi and Martha Arroyo conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival at approx 10:00 a.m., LPA met with staff and explained the reason for the visit. Licensee was contacted and stated they can only be at the facility at approx. 4pm. At approx 10:02 a.m. LPA's conducted physical plant, interviewed staff, residents and reviewed and obtained copies of facility documents. LPA's observed a sufficient supply of perishable and non-perishable food properly stored at this time. LPA's and staff inspected produce that was stored in fridge drawers. LPA's observed produce to appear fresh and free of any signs of mold at this time. At approx 10:30 a.m. LPA's observed staff mopping floor. On 10/16/2025, during a case management visit conducted from 9:30 a.m. to 4:00 p.m., LPA observed Staff #1 (S1) present inside the facility. At that time, S1 was not associated. S1 was instructed to leave the facility. On 10/31/2025 , LPA received information indicating that S1 continued to provide services to residents in care. During interviews with Resident #1 (R1) and Resident #2 (R2), both residents stated that they have observed S1 on multiple evenings, sleeping in Bedroom #1, since the LPA’s visit on 10/16/2025 Interviews with residents today indicated that S1 was present and on duty at the facility from the morning through the evening on Saturday 11/01/2025, at which time Staff #2 (S2) arrived to provide relief. It was further reported that S2 has remained on duty without relief since assuming the evening shift on Saturday. LPA's contacted the tentative new Administrator regarding pending documentation and they stated they will provide documents today, however they can't provide the LIC 308 until after their Doctor's appointment on Wednesday 11/05/2025. At approx 12:12 p.m. LPA observed staff preparing lunch. LPA's records review indicated the following: S2 does not have a valid / first aid CPR on file to review. LPAs conducted medications review at approximately 01:15 p.m. Medications were observed to be given as prescribed at this time. During Case management visit on 10/31/2025; LPA cited the following: CCR 87355( e)(2) with a due date of 11/03/2025 CCR 87307(a)(2)(B) with a due date of 11/07/2025 , however same the same violation occurred on Saturday New 11/01/2025. During Case Management visit on 10/22/2025; LPA cited the following: CCR 87412 (g) with a due date of 10/31/2025. During Case Management visit on 10/16/2025; LPA cited the following CCR 87415(a), with a due date of 10/24/2025 CCR 87411(c ), with a due date of 10/24/2025 CCR 87211(a)(1)(D), with a due date of 10/24/2025 HSC 1569.58 (a)(2), with a due date of 10/17/2025 CCR 87216(a), with a due date of 10/17/2025 During Case Management visit on 10/13/2025; LPA cited the following: CCR 87307 (a)(3)(F), with a due date of 10/24/2025 CCR 87303 (g)(1), with a due date of 10/24/2025 During the visit, LPA's observed S2 frequently leave residents unattended to step outside. An immediate civil penalty of $10,150 is assessed today for failure to correct multiple citations. Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC809-D). LPA conducted exit interview with Licensee over the phone along with staff onsite, deficiencies cited, civil penalties assessed, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Nov 3, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(C)(1) · Plan of correction due date: Nov 14, 2025

Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidenced by: Based on interviews and records review the licensee did not comply with the section cited above as S2 was unable to provide a valid first aid / CPR training which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 3, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance and send to LPA via email by COB 11/14/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468.2(a)(4) · Plan of correction due date: Nov 14, 2025

To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on interviews and records review the licensee did not comply with the section cited above as S2 has been working since evening of 11/01/2025, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 3, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance and send to LPA via email by COB 11/14/2025.

Allegation investigated: Staff did not provide proper first aid treatment to resident in care Staff yelled at residents in care Staff did not meet the residents' diapering care needs in a timely manner Staff did not clean resident's room Staff did not provide laundry services to resident in care Staff did not provide nutritious meals to residents in care Staff did not provide proper medication assistance to residents in care Facility is malodorous

**This is the amended report to update information. The intial report was delivered 10/13/2025 and 07/21/2025***Licensing Program Analysts (LPA) Brian Balisi conducted a subsequent complaint visit to investigate the allegations list above. During today’s visit, LPA met with staff and explained the reason for the visit. Licensee stated they would be onsite shortly. On 07/21/2025, from 09:45 a.m. to 03:45 p.m., LPA Balisi conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 10:00 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. On 09/04/2025, from 09:30 a.m. – 05:15 a.m., LPA’s Balisi, Arroyo and LPM Perera conducted physical plant, interviewed four (4) residents, and staff while on site for a separate investigation. On 10/13/2025, from 09:40 a.m. to 03:00 p.m. LPAs Balisi and Arroyo conducted a subsequent complaint visit. LPA’s conducted physical plant, interviewed staff, residents and reviewed and obtained copies of additional pertinent documentation relevant to the investigation Substantiated continued from 9099 It was reported that “Staff did not provide proper first aid treatment to resident in care” as it was alleged that Resident #1 (R1) fell and was not provided first aid or care in a timely manner. Interviews conducted and records review revealed on 07/15/2025, R1 fell in the hallway near the bathroom. LPA’s interview with Staff #1 (S1) revealed they assisted R1 back to their room and offered R1 some ice, but R1 declined. S1 also stated they did not inform the Administrator or offer to call 911 after the fall. Additionally LPA’s interview with R1 revealed that although they did not feel like they were in any pain after the fall, staff only offered minimal assistance. The next day R1 decided to admit themselves into a local hospital. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff did not provide proper first aid treatment to resident in care” has been deemed Substantiated at this time. It was reported that "Staff yelled at residents in care" , as it was alleged that when resident’s requests assistance staff speak to them in inappropriate manner. Interviews conducted with five (5) residents in care revealed all (5) residents have observed S1 respond back to them in an inappropriate manner when requesting assistance with basic services such as food, toileting and transferring. LPA’s interview with S1 and Administrator revealed they denied ever speaking to residents in an inappropriate manner. Based on information gathered during the investigation the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff yelled at residents in care” is Substantiated at this time. It was reported that "Staff did not meet the residents' diapering care needs in a timely manner" as it was alleged that residents are left in soiled diapers due to staff not changing them in a timely manner. Interviews conducted with five (5) residents during the complaint investigation revealed that Resident #2 (R2) routinely requested diaper changes or for their Foley catheter bag to be emptied, but these requests were not addressed in a timely manner. Residents, including R2, reported that R2’s catheter bag was frequently more than half full. Additionally, R2 stated they do not have regular bowel movements; however, when they did, S1 often delayed responding to requests for assistance, sometimes for more than 10 minutes. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not meet the residents' diapering care needs in a timely manner"” has been deemed Substantiated at this time continued from 9099-C It was reported "Staff did not clean resident's room", as it was alleged that R1 has not had their bedding changed and staff have not swept since they moved in. Interviews conducted with five (5) residents in revealed (4 ) out of (5) residents have experienced not having their bed sheets changed for a prolonged period of time while (1) resident stated they have had their bed sheets changed in a timely manner. Furthermore all (5) residents stated they have not observed S1 proactively attempt to keep their rooms clean as they have had to request S1 to empty trash or dust and wipe down hard surfaces. During physical plants , LPA’s have observed food particles near dining table and overflowing trash cans on multiple occasions. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not clean resident’s room” has been deemed Substantiated at this time. It was reported that, that "Staff did not provide laundry services to resident in care", as it was alleged that R1 has not had their laundry service since they moved in. Interviews conducted with five (5) residents in care revealed (4) out of (5) residents have had concerns with their laundry not being completed in a timely manner or not being completed at all. Furthermore residents stated on several occasions staff informed them they would complete their laundry, but they never did and on another occasion residents stated there was no laundry detergent available. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not provide laundry services to resident in care” has been deemed Substantiated at this time It was reported that "Staff did not provide nutritious meals to residents in care" as it was alleged that residents are not provided with 3 nutritious meals a day. Interviews conducted with five (5) residents revealed all (5) have had concerns with meal services stating that on multiple instances food was not provided in a timely manner, food was not provided according to a residents special diet, and there was not a variety of food served. During physical plants over the course of the investigation, LPA’s have not observed a sufficient supply of perishable and non-perishable food properly stored on multiple visits. On 09/04/2025, during an annual inspections, LPA did not observe staff prepare lunch in a timely manner for residents in care. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not provide nutritious meals to residents in care” has been deemed Substantiated at this time. Continued from 9099-D It was reported that “ Staff did not provide proper medication assistance to residents in care”, as it was alleged that R1 was allowed to obtain their own medications from the medication cabinet and administer themselves. Interviews revealed that R1 was allowed access to their medication, which was stored in a medication cabinet located in the kitchen, upon request. On 07/10/2025, between approximately 9:46 a.m. and 3:00 p.m., during a separate complaint investigation (Complaint Control #29-AS-20250709155231), LPA observed R1’s medications being stored in R1’s room. During that same visit, staff relocated the medications to the designated centrally stored medication area. In an interview, Staff #1 (S1) stated that R1 would become agitated if not given access to their medications at the time of administration, so staff permitted R1 to access their medication as needed. On 09/04/2025, during an annual inspection visit, LPA observed medications stored in Resident #2 (R2)’s room. . During that same visit, staff relocated the medications to the designated centrally stored medication area. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not provide proper medication assistance to residents in care” has been deemed Substantiated at this time. It was reported that facility is malodorous, as it was alleged that the facility smelled like urine due to staff not keeping the facility well maintained. Interviews conducted with five (5) residents in care revealed that all (5) residents have had concerns with S1 not being proactive in keeping facility clean and free from smells. Furthermore (3) out of (5) residents stated they have observed the smell of urine and they believe it is due to staff not changing R2’s urine bag in a timely manner. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “facility is malodorous” has been deemed Substantiated at this time. Civil penalties in the amount of $1,250 are assessed today for repeat violations. The Licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f).Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D). Licensee contacted LPA at approx 11:20 a.m. and stated they were unable to be onsite during the visit, but stated staff will sign in their place. LPA conducted exit interview with Licensee over the phone along with staff onsite, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 31, 2025 · control 29-AS-20250716115150

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Nov 3, 2025

The licensee shall immediately telephone 9-1-1 if an injury or other circumstance... apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as, S1 did not attempt to call 911 or the Administrator after R1 had a fall, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to submit a written plan on how they will ensure residents will receive timely medical care and submit to CCL via email by COB 11/03/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Nov 3, 2025

To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by Based on interviews, the licensee did not comply with the section cited as it was reported that residents were not treated with dignity and respect by S1 on multiple occasions, which poses a poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 11/03/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Nov 3, 2025

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as R1 had access to medication for all residents in care, which poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review reg cited and submit a written plan to ensure future compliance and send to LPA via email by 11/03/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 7, 2025

To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on interviews the licensee did not comply with the section cited above as R2 was left in a soiled diaper for extended periods and their foley Cather bag was not emptied in a timely manner which posed a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to CCL via email by COB 11/07/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 7, 2025

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 was not met as evidenced by: Based on interviews and observations the licensee did not comply with the section cited above as bedrooms and common areas were not kept clean which posed a potential health, safety or personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure facility is kept clean for future compliance then submit to CCL via email by COB 11/07/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(F) · Plan of correction due date: Nov 3, 2025

Basic laundry service (washing, drying, and ironing of personal clothing). This requirement was not met as evidenced by: Based on interviews the licensee did not comply with the section cited above as laundry services were not provided to residents in care in a timely manner, which posed a potential health, safety or personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to CCL via email by COB 11/07/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(1) · Plan of correction due date: Nov 3, 2025

Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day...not more than (15) hours shall elapse between the third and first meal. This requirement was not met as evidenced by: Based on interviews and observations the licensee did not comply with the section cited above as nutrious meals, snacks and beverages were not provided to residents in a timely which posed a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to CCL via email by COB 11/07/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Nov 3, 2025

Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by: Based on observation the licensee did not comply with the section cited above as R1 had access to medication for all residents in care, which poses an immediate health, safety or personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review reg cited and submit a written plan to ensure future compliance and send to LPA via email by 11/07/2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival at approx 09:40 a.m., LPA met with staff and explained the reason for the visit. Licensee was contacted and stated they will be at the facility soon. At approx 10:02 a.m. LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of facility documents. LPA observed a sufficient supply of perishable and non-perishable food properly stored at this time. LPA and staff inspected produce that was stored in fridge drawers. LPA observed produce to appear fresh and free of any signs of mold at this time. Interviews with residents revealed they have been provided with sufficient meals and snacks since LPA's last visit on 10/27/2025 and residents did not express any concerns at this time. On 10/16/2025, during a case management visit conducted from 9:30 a.m. to 4:00 p.m., LPA observed Staff #1 (S1) present inside the facility. At that time, S1 was not associated. S1 was instructed to leave the facility.Today the LPA received information indicating that S1 continued to provide services to residents in care. During interviews with Resident #1 (R1) and Resident #2 (R2), both residents stated that they have observed S1 on multiple evenings, sleeping in Bedroom #1, since the LPA’s visit on 10/16/2025 On 10/28/2025, the Licensee provided LPA with the following documents to update facility administrator: Administrator Certificate - exp 02/05/2027, LIC 308 ,LIC 501, LIC 503, Board Resolution , Criminal Record Statement, Employee rights. LPA requested licensee to update the following LIC 308, LIC 501 and LIC 503. Licensee stated they are waiting on the new administrator to complete and will send to LPA as soon as they receive them. Continued from 809 The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Civil penalties in the amount of $2,000 will be assess today for failure to correct violation and repeat violations. The Licensee was informed that failure to correct the deficiencies may result in additional civil penalties. During the visit, the LPA did not observe any immediate health or safety concerns. Licensee contacted LPA at approx 11:20a.m. and stated they were unable to be onsite during the visit, but stated staff will sign in their place. LPA conducted exit interview with Licensee over the phone along with staff onsite, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 31, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Nov 3, 2025

All facilities shall have a qualified and currently certified administrator... facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Based on interviews and records review the licensee did not comply with the section cited above as the facility has not hired a qualified Administrator, which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review section cited and email LPA with completed documents for new Administrator within 48 hours.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: Nov 3, 2025

Criminal Record Clearance: All individuals subject to a criminal record review ...(b) shall prior to working... in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department…This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as a criminal background fingerprint clearance was not conducted for S1, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, an updated LIC 500 and a written plan on how they will ensure future compliance then send to LPA via email by COB 11/03/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(2)(B) · Plan of correction due date: Nov 7, 2025

(2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements:... storage area, shed or similar detached building. This requirement is not met as evidenced by: Based on interviews the licensee did not comply with the section cited above as upon arrival into facility, S1 stated they were sleeping, which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 31, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 11/07/2025.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival at approx 10:00 a.m., LPA met with staff and explained the reason for the visit. Licensee was contacted and stated they will be at the facility soon. Licensee arrived at approx 11:30 a.m. At approx 10:02 a.m. LPA conducted physical plant, interviewed staff and. LPA and staff inspected produce that was stored in fridge drawers. LPA observed produce to appear fresh and free of any signs of mold at this time and Leftover food were observed to be properly sealed, and labeled. LPA observed a sufficient supply of perishable and non-perishable food properly stored at this time. Interviews with residents revealed they have been provided with sufficient meals, snacks and assistance from staff since LPA's last visit on 10/22/2025. In addition, residents did not express any concerns at this time. At approx 01:15 p.m. LPA observed residents eating at the dining table. Residents were being served chicken soup and a vegetable soup. At approx. 02:12 p.m. LPA observed staff cleaning the facility. During the visit, Licensee stated they have found a new Administrator and will have all required documents sent to LPA by end of day tomorrow. During the visit, the LPA did not observe any immediate health or safety concerns. Exit interview conducted with Licensee and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 27, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival at approx 09:30 a.m., LPA met with staff and explained the reason for the visit. Licensee was contacted and stated they will be at the facility soon. Administrator Yuan Yuan Han arrived shortly after. At approx 09:50 a.m. LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of facility documents. LPA observed a sufficient supply of perishable and non-perishable food properly stored at this time. Interviews with residents revealed they have been provided with sufficient meals and snacks since LPA's last visit on 10/20/2025. In addition, residents did not express any concerns at this time. Interview with Staff #1 (S1) revealed today was their first day and received some training from Staff #2 (S2), prior to the start of S1's shift. At approx 11:02 a.m. LPA conducted records review and it was revealed S1 does not have a full facility file on site for review. At approx 01:30 p.m. LPA conducted medication review. All medications including PRNs were labeled, stored and inaccessible to residents in care. Medications were observed to be administered as prescribed at this time. During the visit, the LPA did not observe any immediate health or safety concerns. LPA reviewed the facility’s history of non-compliance and discussed ongoing compliance expectations with the Administrator and Licensee. Both the Administrator and Licensee acknowledged the discussion and affirmed their understanding of the need to maintain compliance. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Civil penalties in the amount of $250 will be assessed today due to repeat violation. The Administrator was informed that failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted with Administrator, appeal rights discussed, and a copy of this report issuedthe state’s words, verbatim · CDSS document, Oct 22, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(g) · Plan of correction due date: Oct 31, 2025

All personnel records shall be maintained at the facility. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as S1 did not have a complete file onsite for review, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 22, 2025

Plan of correction: Licensee representative agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/31/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(c)(1)(A) · Plan of correction due date: Oct 31, 2025

For staff who assist with personal activities of daily living, there shall be documentation of at least ten hours of initial training within the first four weeks of employment... specified in Section 87411(c)(2). This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as S1 did not have at least (10) hours of initial training , which poses a potential health and safety concern for residents in care.the state’s words, verbatim · CDSS document, Oct 22, 2025

Plan of correction: Licensee representative agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/31/2025.

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo conducted a Case Management - Other visit to the facility. The purpose of the visit is to hand deliver an Immediate Exclusion Order to facility administrator Lala Soghomonyan. LPAs arrived at the facility at approx 10:45 a.m. Upon arrival LPA's met Administrator Lala Soghomonyan. Licensee was contacted via telephone and arrived shortly after the visit began. Entrance interview conducted. It was determined that due to chronic noncompliance resulting in violations of Basic Services, Personal Rights, Neglect, Lack of Care and Supervision, Prohibited Health Conditions, Pre-Admission Appraisal, Maintenance and operation, Reporting Requirements, Personnel Requirements and training, Resident Records, Medical Care Services, Food Services, Physical Plant, Criminal Record Clearance, Operating Requirements, Conduct Inimical, Administrator Qualifications and Financial Abuse, necessitating the Order for Immediate Exclusion from the facility. During today’s visit, an “Order To Individual For Immediate Exclusion From All Facilities” was hand delivered to Lala Soghomonyan for this facility along with (Angel Ray's Senior Care Inc, #197610759, Pegasus Senior Care Inc, #197610789, Dignity Senior Care, Inc #197610582, Leo's Assisted Living II #197610054, ). Lala Soghomonyan was also provided copies of the “Order To Licensee/Facility Of Immediate Exclusion From Facility” for all facilities she is associated to. LPAs witnessed Lala Soghomonyan leave the facility on this date. The LPAs also hand delivered the “Order To Licensee/Facility Of Immediate Exclusion From Facility” of Lala Soghomonyan to licensee Sarkis Dovlatyan and to Ejmin Gharib, the licensee of the pending application (Age Well Assisted Living #195850516), along with a copy of the “Order To Individual Of Immediate Exclusion From All Facilities” issued to Lala S. During the visit, LPAs discussed with Sarkis that he needs to provide the Department with the documents for a new administrator along with an updated LIC500 within 48 hours. At approximately 10:50 a.m., the LPAs conducted a physical plant tour to ensure there were no health or safety concerns. No immediate health and safety concerns were observed during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 20, 2025

Allegation investigated: Staff did not provide adequate food service for resident Staff did not ensure that resident's hygiene needs were met Staff confined resident to their room Staff yelled at resident

Licensing Program Analysts (LPA's) Brian Balisi and Martha Arroyo conducted a subsequent complaint visit to investigate the allegations list above. During today’s visit, LPA met with staff and explained the reason for the visit. Administrator Lala Soghomonyan was contacted and arrived at approx. 11:10 a.m. On 09/02/2025, from 11:29 a.m. to 05:15 p.m., LPA Conway conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 11:30 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. Today LPA's conducted physical plant, interviewed staff and residents as well as reviewed and obtained copies of additional pertienent records relevant to the investigation. It was reported that “Staff did not provide adequate food service for resident” as it was alleged that Resident #1 (R1) was only fed once a day and was denied drinking water when the requested. Substantiated Interviews conducted on 09/02/2025, with Four (4) residents in care revealed that three (3) out of four (4) resident stated they were not provided a sufficient amount of meals daily and at times were denied a glass of water when requested. One (1) resident did not express any concerns with food. During the Annual Continuation inspection of the physical plant conducted on 09/04/2025, between 9:30 a.m. and 5:15 p.m., LPAs Balisi and Arroyo observed that the facility did not have an adequate supply of perishable and non-perishable food stored in either the refrigerator or the pantry closet located near the door. During today’s physical plant LPA’s observed fresh produce, frozen protein, bread, tortillas and various products used for food preparation properly stored. LPA’s interviews with the (2) residents currently in care revealed that each resident did not express any concerns for food service. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff did not provide adequate food service for resident” has been deemed Substantiated at this time. It was reported that “ Staff did not ensure that resident’s hygiene needs were met”, as it was alleged R1 has not received a shower. Interviews conducted on 09/02/2025, with four (4) residents in care revealed that all (4) have had concerns with availability of personal hygiene items such as soap, shampoo, and laundry detergent. During a Case management – Deficiencies visit conducted on 10/13/2025 between 09:40 a.m. and 03:00 p.m. LPAs Balisi and Arroyo observed that the facility did not have an adequate supply of paper towels and laundry detergent. During today’s physical plant LPA’s did not observed an adequate supply of paper towels. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff did not ensure that resident's hygiene needs were met ” has been deemed Substantiated at this time. It was reported that "Staff confined resident to their room", as it was alleged that R1 was not allowed to walk outside of their room. Interviews conducted on 09/02/2025, with four (4) residents in care revealed concerns regarding being confined to their rooms. Three (3) of the four (4) residents reported that the hallway door separating the bedroom areas from the common area was observed to be closed and locked on multiple occasions. One (1) resident, who requires assistance transferring in and out of bed, reported not receiving the necessary support from staff. Another resident, who is legally blind, stated that staff did not provide assistance with safely ambulating throughout the facility. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff confined resident to their room” has been deemed Substantiated at this time. It was reported that “Staff yelled at resident”, as it was alleged that R1 was yelled at by staff for using the bathroom. Interviews conducted 09/02/2025, with four (4) residents in care revealed concerns regarding former staff. All (4) residents reported concerns that previous Staff #1 (S1) spoke to residents in an unpleasant manner and did not treat them with dignity and respect when residents would make requests for food, water or personal hygiene items. LPA’s interviews with the (2) residents currently in care revealed they did not express any concerns with the current staff on shift. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegation that “Staff yelled at resident” has been deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D). Administrator was informed that failure to correct the deficiencies may result in civil penalties. Administrator left during the visit to attend to a personal matter and stated they would not be able to return to the visit. Licensee was contacted and stated they are unable to be onsite. Exit interview conducted with Staff and Licensee, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 16, 2025 · control 29-AS-20250825222044

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Oct 17, 2025

To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...or barring windows against intruders, with permission from the Department. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited as it was reported that residents were confined to their room on multiple occasions which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 10/17/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 17, 2025

To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited as it was reported that residents were not treated with dignity and respect by S1 on multiple occasions, which poses a poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 10/17/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(1) · Plan of correction due date: Oct 24, 2025

Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day...Not more than fifteen (15) hours shall elapse between the third and first meal. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not comply with the section cited as meals were not provided to residents in a timely manner and a sufficient amount of food was not observed to be stored, which poses a potential, health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 10/24/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(4) · Plan of correction due date: Oct 24, 2025

Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living... as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not comply as a sufficient supply of personal hygiene items were not observed and residents were not provided assistance with showering which poses a potential, health and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure future compliance then send to LPA via email by COB 10/24/2025.

Allegation investigated: Facility staff financially abusing resident

Licensing Program Analysts (LPA's) Brian Balisi and Martha Arroyo conducted a subsequent complaint visit to investigate the allegation list above. During today’s visit, LPA met with staff and explained the reason for the visit. Administrator Lala Soghomonyan was contacted and arrived at approximately 11:11a.m. On 09/02/2025, from 09:40 a.m. to 03:00 p.m., LPA’s Balisi and Arroyo conducted an initial 10-day complaint visit to investigate the allegations listed above. At approximately 09:50 a.m., the LPA conducted a physical plant tour, interviewed staff, resident and reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that “Facility staff is financially abusing resident”, as it was alleged that Resident #1 (R1), gave their EBT card to the Administrator to use to purchase food and other items for the facility. Interviews conducted with Administrator and R1 revealed a several months ago, R1 provided the Administrator with lists of grocery items to purchase. The Administrator agreed to use R1’s EBT card to make the purchases. Substantiated However, R1 reported that they have not received all of the requested items. R1 was unable to recall the specific items from the list and declined to further discuss the matter. Additionally, R1 stated before they provided the card to the Administrator, their card had a balance of approximately $900. On 10/16/2025, R1 confirmed the card balance was $0.00. The most recent transaction on the card occurred on 09/15/2025, in the amount of $107.00. The Administrator stated in an interview that they recently attempted to make purchases for R1 but were unable to complete the transaction due to the card being declined. The Administrator then returned the card to R1. Furthermore, Administrator stated the card was only used to make purchases for R1, however there were no records of receipts or documentation on site for LPAs to review. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Facility staff is financially abusing resident” has been deemed Substantiated at this time. Administrator left during the visit to attend to a personal matter and stated they would not be able to return to the visit. Licensee was contacted and stated they are unable to be onsite. Exit interview conducted with Staff and Licensee, appeal rights discussed, and a copy of this report issuedthe state’s words, verbatim · CDSS document, Oct 16, 2025 · control 29-AS-20251013092407

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Oct 17, 2025

To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by: Based on interviews and records, the licensee failed to comply with the section cited. R1 gave the Administrator their EBT card for purchases but did not receive requested items, and the card now has a zero balance, posing an immediate personal rights risk to residents.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/17/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20251013092407). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation. During the course of the investigation, it was revealed that Staff #1 (S1), an employee of Age Well Assisted Living Inc., collected the Electronic Benefits Transfer (EBT) card from Resident #1 (R1) several months ago. R1 had provided S1 with a list of items to purchase on their behalf. However, as of today, S1 has not provided the requested items, and the EBT card balance is currently $0. Additionally, a review of the facility’s Affidavit Regarding Client/Resident Cash Resources (LIC 400) indicates that the facility is not authorized to handle any cash resources belonging to residents. However, staff assisted the resident with safeguarding their funds. As a result, the facility is required to maintain Surety Bond Insurance. Yet, the facility did not obtain this insurance until 10/13/2025, after being informed of the necessary requirement to handle resident’s monies. Furthermore, The following deficiencies were cited from the California Code of Regulations, Title 22 and California Health & Safety Code. (See LIC 809-D). The Administrator was informed that failure to correct deficiencies may result in future civil penalties. Exit interview conducted, appeal rights discussed, and a copy of report provided.the state’s words, verbatim · CDSS document, Oct 16, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.58(a)(2) · Plan of correction due date: Oct 17, 2025

1569.58 (a) (2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California. This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above as facility staff had access to residents’ EBT card, which posed an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/17/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87216(a) · Plan of correction due date: Oct 17, 2025

Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. This requirement was not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above as the facility was handling the residents monies wihtout having Surety bind insurance, which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/17/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo conducted a Case Management - Deficiencies visit to address deficiencies observed during an unrelated complaint investigation. Entrance interview conducted. At approximately 9:50 a.m., the LPAs conducted a physical plant tour to ensure there were no health or safety concerns. During the tour, at approximately 9:55 a.m., the LPAs observed an individual sleeping in Bedroom #1. Interviews revealed that the individual had been working evening shifts at the facility for the past three days. However, the LPAs reviewed the list of individuals associated to the facility and did not observe Staff #1 (S1) on this list. The Administrator stated that the individual had been hired to perform housekeeping duties and was unaware that fingerprint clearance was required for S1. S1 left the premises during the LPAs’ visit. Additionally, the Administrator reported that Staff #2 (S2) is responsible for providing care and supervision to residents during the night shift. A review of S2’s personnel file revealed that their most recent first aid certification was completed in 2019, and the last documented training occurred in 2020. Administrator was not aware that S2 was still in the facility. Interviews further revealed that four (4) residents were transported to the hospital via ambulance on 10/07/2025 and 10/08/2025. However, a review of the facility’s records showed that incident reports were not submitted to the Department within the required seven (7) days of the occurrences, as mandated by reporting regulations. Administrator provided reports for (2) residents and was reminded to provide the other (2) reports , but they are still pending. Moreover, it was found that some residents have been refusing prescribed medications, yet the facility failed to notify either the residents’ physicians or the Department regarding these refusals. Furthermore, on 10/06/2025, the LPAs were informed that the Community Care Licensing Division (CCLD) Investigations Branch (IB) had contacted the Administrator and requested documentation related to an open investigation. The LPAs spoke with the Administrator to reiterate the importance of submitting the requested documentation. As of today, the requested documents have not been submitted to the CCLD Investigations Branch. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Civil penalties in the amount of will be assessed today due to repeat violations for citations: Criminal Record Clearance – 87355(e)(2) from 10/06/2025, and Administrator Qualifications and Duties – 87405(d) (d) from 09/04/2025. The Administrator was informed that failure to correct the deficiencies may result in additional civil penalties. Administrator left during the visit to attend to a personal matter and stated they would not be able to return to the visit. Licensee was contacted and stated they are unable to be onsite. Exit interview conducted with Staff and Licensee, appeal rights discussed, and a copy of this report issuedthe state’s words, verbatim · CDSS document, Oct 16, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Oct 17, 2025

Criminal Record Clearance: All individuals subject to a criminal record review ...(b) shall prior to working... in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department…This requirement was not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as a criminal background fingerprint clearance was not conducted for S1, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: S1 exited the facility during the visit. Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/17/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87755(b) · Plan of correction due date: Oct 17, 2025

Inspection Authority of the Licensing Agency (b) The licensee shall ensure that provisions are made for the examination of all records relating to the operation of the facility. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above as they have not submitted any documents requested by the Community Care Licensing Investigations Branch, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/17/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87415(a) · Plan of correction due date: Oct 24, 2025

The following persons providing night supervision from l0:00 p.m. to 6:00 a.m... shall be available as indicated below to assist in caring for residents in the event of an emergency. This requirement was not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as the nocturnal staff does not have first aid certification on file, which poses a potential health and safety risk to persona in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/24/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c) · Plan of correction due date: Oct 24, 2025

All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement was not met as evidenced by:the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/24/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Oct 24, 2025

Each licensee shall furnish to the licensing agency such reports as the Department may require... Any incident which threatens the welfare, safety or health of any resident or unexplained absence of any resident. This requirement was not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above as (4) residents were sent out to the hospital on 10/07/25 and 10/08/25 and have not sent all incident reports to the Department, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/24/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d) · Plan of correction due date: Oct 17, 2025

The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. This requirement is not met as evidenced by: Based on interviews and records review the licensee did not comply with the section cited above as the Administrator did not demonstrate sufficient knowledge, availability and qualifications as an Administrator, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan on how they will ensure future compliance then send to LPA via email by COB 10/17/2025.

Allegation investigated: Staff is not following resident's care plan. Staff leaves resident in bed for extended periods of time. Staff confiscated resident's wheelchair and walker. Staff are unable to communicate with resident due to language barrier. Facility kept incomplete resident files.

Licensing Program Analysts (LPA's) Brian Balisi and Martha Arroyo conducted a subsequent complaint visit to investigate the allegations list above. During today’s visit, LPA met with staff and explained the reason for the visit. Administrator Lala Soghomonyan was contacted , but they stated they were unable to be at the facility until the afternoon. Licensee Sarkis Dovlatyan was contacted and stated they were unable to be at the facility until the afternoon, but will contact Lala to ensure they are able to be present. On 08/19/2025, from 10:00 a.m. to 03:00 p.m., LPA Balisi conducted an initial 10-day complaint visit to investigate the allegation listed above. At approximately 10:00 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that "Staff is not following resident's care plan", "Staff leaves resident in bed for extended periods of time" and “Staff confiscated resident’s wheelchair and walker” as It was alleged that Resident #1 (R1) requires assistance with bathing and transferring out of bed; Substantiated however, staff have not been providing this assistance. Interviews conducted and records review revealed that R1’s physician’s report indicates R1 needs help with bathing, dressing, toileting, and is unable to transfer in and out of bed without assistance. During interviews, R1 and Resident #2 (R2), R1’s roommate since approximately July 2025, stated that R1 only began receiving help with bathing and showers toward the end of August 2025. Prior to that, staff had not been assisting R1 with bathing or showering. Additionally, interviews revealed that R1’s wheelchair is typically stored in the closet and only brought out for medical appointments. Interviews further revealed that staff have not encouraged or assisted R1 in getting out of bed. LPA’s interviews with staff and the facility administrator denied restricting R1’s use of the wheelchair and stated that R1 has not requested to use it within the facility. Based on information gathered during the investigation, the department has sufficient evidence to confirm these allegations occurred. Therefore, the allegations that “Staff is not following resident’s care plan”, “Staff leaves resident in bed for extended periods of time” , and “Staff confiscated resident’s wheelchair and walker” have been deemed Substantiated at this time. It was reported that “Staff are unable to communicate with Resident due to language barrier” as it was alleged that R1 has difficulty communicating with Staff. LPA’s interview conducted with Interviews conducted with three (3) residents in care revealed that all (3) residents stated they could only communicate with Staff #1 (S1) through use of a translating app on staff's phone. Interview with R1 stated they need staff to speak into R1’s phone for communication, but staff are unable to effectively communicate. The (3) residents did not express any immediate concerns for their health and safety as staff are able to provide basic services, but each did express potential concerns that if there was an emergency they would not be able to communicate with the emergency personnel. LPA’s interview with S1 revealed that S1 was able to communicate with LPA through a translation app. While using translating app, S1 was able to communicate regarding facility business and resident care needs and they stated they would contact the Administrator in the event of an emergency. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “Staff are unable to communicate with Resident due to language barrier” has been Substantiated at this time. Continued from 9099-C It was reported that “Facility kept incomplete resident files” as it was revealed during a file review for R1 on 08/19/2025, that files were not fully completed including Preplacement Appraisal (LIC 603), Resident Appraisal (LIC 603A), Appraisal / Needs and Services Plan (LIC 625), and Physician’s Report (LIC 602). Administrator stated they could not recall why forms were incomplete, but will work on getting them completed. On 09/04/2025, during an Annual Continuation Visit, LPA's records review revealed three (3) resident files were observed to be incomplete along with R1. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “Facility kept incomplete resident files” has been Substantiated at this time. Civil penalties in the amount of $500 are assessed today for repeat violations. The Licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D). Administrator contacted LPAs at approx 01:57 p.m. and stated they were unable to be onsite during the visit, but stated staff will sign in their place. Licensee stated they were unable to be onsite. LPA conducted exit interview with Licensee over the phone along with staff onsite, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 13, 2025 · control 29-AS-20250812110937

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(a) · Plan of correction due date: Oct 14, 2025

The services provided by the facility shall be conducted so as to continue and promote, to the extent possible... both in the facility and in the community. This requirement was not met as evidenced by: Based on interviews and records review, the Licensee failed to complete resident files, preventing staff from following proper care plans, which posed an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: Licensee agreed to ensure full facility files are kept onsite, conduct training with staff on how to use files and provide a written plan on how they will ensure future compliance, then send to LPA via email by COB 10/14/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Oct 24, 2025

To have a reasonable level of personal privacy in accommodations... communications, telephone, conversations... meetings of resident and family groups. This requirement was not met as evidence by: Based on interviews and observations, the licensee did not ensure there was staff scheduled who can communicate with residents that they can fluently communicate with, which poses a potential personal rights and health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: Licensee provided an updated LIC 500, and agreed to review section cited and ensure to have staff scheduled that can communicate with residents in care and outside agencies. Licensee also agreed to submit statement of understanding via email to CCL by COB 10/24/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Oct 24, 2025

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 was not met as evidenced by: Based on interviews and records review the licensee did not comply with the section cited above as (4) out of (4) records reviewed were not fully completed, which poses a potential health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: Licensee agreed to ensure full facility files are kept onsite and provide a written plan on how they will ensure future compliance, then send to LPA via email by COB 10/14/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPA's) Brian Balisi and Martha Arroyo conducted a subsequent complaint visit to investigate the allegations list above. During today’s visit, LPA met with staff and explained the reason for the visit. Administrator Lala Soghomonyan was contacted , but they stated they were unable to be at the facility until the afternoon. Licensee Sarkis Dovlatyan was contacted and stated they were unable to be at the facility until the afternoon, but will contact Lala to ensure they are able to be present. At approximately 10:05 a.m., the LPAs conducted a physical plant tour and observed that paper towels were not available for resident use in either the bathroom or the kitchen. Additionally, laundry detergent was not readily accessible. Interviews with residents revealed that they have requested certain items, including laundry detergent, from the Administrator; however, the requested items had not been provided and as a result, residents have been unable to do their laundry for approximately one week. The following deficiencies were cited from the Title 22 California Code of Regulations. (See LIC 809-D). Failure to correct the deficiencies may result in additional civil penalties. Administrator contacted LPAs at approx 01:57 p.m. and stated they were unable to be onsite during the visit, but stated staff will sign in their place. Licensee stated they were unable to be onsite. LPA conducted exit interview with Licensee over the phone along with staff onsite, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 13, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a)(3)(F) · Plan of correction due date: Oct 24, 2025

Living accommodations and grounds shall be related to the facility's function. (3) Equipment and supplies necessary... including hygiene items of general use…This requirement was not met as evidenced by: Based on observations, the licensee did not comply with the section cited above as there were no paper towels available for resident use during the visit, which poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to CCL via email by COB 10/24/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(g)(1) · Plan of correction due date: Oct 24, 2025

Facilities which have machines and do their own laundry shall: Have adequate supplies available and equipment maintained in good repair. Based on observations, the licensee did not comply with the section cited above as there is no laundry detergent available for residents to do their own laundry, which poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: Licensee agreed to review section sited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to CCL via email by COB 10/24/2025

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Sandra Urena and Trevor Byrne conducted an unannounced case management - deficiencies visit. LPAs arrived to the facility at 10:58 AM. LPAs met with the facility staff #1 (S1) who contacted the facility Administrator Lala Soghomonyan via telephone call. The Administrator arrived to the facility at 11:49 AM and the licensee representative arrived at 02:06 PM. Entrance interview was conducted and the reason for the visit was explained. During today’s visit, the LPAs conducted a physical plant tour to ensure there are no health and safety hazards, conducted a file review for three (3) residents, one (1) staff, and conducted interviews with the Administrator, one (1) staff member, five (5) residents, and the licensee representative between 11:00 AM and 04:00 PM. During record review LPAs observed one (1) staff file to be missing documents including but not limited to: 1st aid certification, required trainings, and documentation of fingerprint clearance/exemption. Continued on LIC 809C. Upon arriving to the facility LPAs were greeted by S1 who allowed LPAs entry to the facility. After gaining entry to the facility S1 left the facility and was unable to be located by LPAs. LPAs did not observe another staff member present at the facility until the Administrator arrived at 11:49 AM. LPAs informed the Administrator that absence of supervision is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (10/07/2025). LPA informed Administrator that failure to ensure adequate staff supervision may result in the assessment of additional civil penalties. Interviews with the licensee representative and residents confirmed the presence of Staff #2 (S2) at the facility earlier in the day. LPAs reviewed the list of individuals associated to the facility and did not observe S2 on this list. LPAs interviewed the Administrator who confirmed that S2 has started the process of obtaining Department of Justice (DOJ) fingerprint clearance, but they have not yet obtained clearance for S2 from DOJ. LPAs informed the Administrator that the presence of an employee at the facility without a valid criminal record clearance or exemption would result in a civil penalty. LPAs observed that the facility was cited on 09/10/2025 for the presence of S2 at the facility without a valid criminal record clearance. LPAs observed that S2 had been employed by the facility since approximately 09/05/2025. LPAs informed the Administrator that an immediate civil penalty in the amount of $3,000 will be assessed on today’s date (10/07/2025) for the presence of S2 at the facility. LPAs informed Administrator that failure to obtain proper clearance for S2 may result in the assessment of additional civil penalties. During the physical plant tour LPAs observed an unlocked drawer in the kitchen that contained knives and other sharp objects accessible to clients in care. The Administrator secured the drawer at the time of the visit. During today’s visit LPAs had a conversation with the licensee representative and Administrator requesting that they be more responsive to CCLD when contacted to avoid delays in communication and for the safety and wellbeing of clients in care. The licensee representative and Administrator expressed understanding and agreed to be more responsive when contacted by CCLD. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies and civil penalties were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 7, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Oct 8, 2025

87468.2(a)In addition to the rights listed in Section 87468.1 (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interviews and observation the licensee did not comply with the section cited above as qualified staff were not present during the initial inspection of the facility; Administrator arrived about an hour after the LPAs arrived at the facility, which posed an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Licensee will submit a plan how they will ensure appropriate resident care and supervision will be provided at all times no later than POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Oct 8, 2025

87309 (a) Storage Space and Access (a) ...the licensee shall ensure that.. knives,...sharp objects,...are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: Based on observation, the licensee did not follow this regulation when they left knives and other sharp objects accessible to residents in care by not locking the kitchen drawer, which poses an immediate Health and Safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Administrator locked the cabinet during the visit. POC cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Oct 8, 2025

Criminal Record Clearance: (e) All individuals subject to a criminal record review ...(b) shall prior to working... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department…This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above as a criminal background fingerprint clearance was not conducted for S2, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Licensee agrees to obtain criminal background fingerprint clearance for S2, and S2 will not work until criminal background clearance has cleared.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87412(a)(c) · Plan of correction due date: Oct 8, 2025

The licensee shall ensure that personnel records are maintained on… each employee. Each personnel record shall contain the following information: (c) Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Based on record review, one (1) out of one (1) personnel record reviewed, did not have proof of CPR/First Aid Training, or required annual training, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 7, 2025

Plan of correction: Licensee agreed to submit a completed personnel file for S1 to CCLD no later than POC due date.

Type of visit: POC

Licensing Program Analyst (LPA) Brian Balisi and Martha Arroyo conducted an unannounced Plan of Correction (POC) visit to follow up regarding the plan of corrections that were due for submission. Upon arrival at approx 10:40 a.m. LPA's met with staff and explained the reason for the visit. Administrator Lala Soghomanyan was contacted and stated they will be at the facility in approx 30 mins. During required annual Continuation visit on 09/04/25,:LPAs cited the following: CCR 87309(a) with a due date of 09/05/2025 CCR 87411(a) with a due date of 09/05/2025 CCR 87405(d) with a due date of 09/05/2025 HSC 1569.69(a)(2) with a due date of 09/05/2025 CCR 87465 (a)(4) with a due date of 09/05/2025 CCR 87465 (a)(6) with a due date of 09/05/2025 CCR 87465(h)(2) with a due date of 09/05/2025 CCR 87208(a) with a due date of 09/12/2025 CCR 87706(a)(1)( C) with a due date of 09/12/2025 CCR 87307(a)(2)(B) with a due date of 09/12/2025 HSC 1569.618(c )(3) with a due date of 09/12/2025 CCR 87413 (a)(1) with a due date of 09/12/2025 Continued from 9099 CCR 87412(g) with a due date of 09/12/2025 CCR 87411 (d) with a due date of 09/12/2025 CCR 87468(c )(2)(A) with a due date of 09/12/2025 CCR 87219 (a) with a due date of 09/12/2025 CCR 87555(b)(21) with a due date of 09/12/2025 CCR 87465(a)(8) with a due date of 09/12/2025 HSC 1569.695(c ) with a due date of 09/12/2025 CCR 87609(b)(4)(A) with a due date of 09/12/2025 CCR 87628(a) with a due date of 09/12/2025 CCR 87632(d)(2) with a due date of 09/12/2025 CCR 87633(h) with a due date of 09/12/2025 CCR 87705(b)(1) with a due date of 09/12/2025 On 09/05/2025 the Administrator initially sent the LPA an email for plans of corrections. On 09/17/2025, LPA reviewed documents and requested Administrator to update documents to clear pending deficiencies. As of today, the plans of corrections for deficiencies cited have not been cleared. On 09/23/2025 during a Case Management - Other visit , LPA cited for the following: CCR 87615 (a)(1) with a due date of 09/24/2025 During today's visit the LPA's observed the following: LPA's observed Staff #1 (S1) briefly inside the facility then relieved by Staff #2 (S2). Resident #1 (R1) was admitted to facility 10/05/2025. During the visit it was revealed resident records were not onsite to review, resident had not been administered their medications as prescribed and resident has a prohibited health condition. Continued from 809-C Resident #2 (R2) and Resident #3 (R3) have prohibited health conditions that were cited on 09/23/2025. As of today, R2 and R3 still reside in the facility. Based on today's findings, Administrator did not demonstrate sufficient knowledge of staffing, resident care and facility daily business. An immediate civil penalty of $56,250.00 is assessed today for failure to correct multiple citations. Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC809-D). Exit interview conducted, deficiencies cited, civil penalties assessed, appeal rights discussed, and a copy of this report issued to the Administrator.the state’s words, verbatim · CDSS document, Oct 6, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Oct 6, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on observation, interview and record review, the Licensee did not comply with section cited above as S1 is not fingerprint cleared, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 6, 2025

Plan of correction: Administrator obtained reliever for S1 to cover shift .Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/06/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(d) · Plan of correction due date: Oct 7, 2025

(d) the administrattor shall have the qulaifcations specified in section 87405(d)(1)through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as the Administrator did not demonstrate sufficient knowledge of new staff and new resident, which poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 6, 2025

Plan of correction: Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/07/2025.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Brian Balisi conducted a Case Management - other visit. LPA met with individual/staff and explained the reason for the visit. LPA contacted Administrator Lala Soghomonyan who stated they will be at the facility for the visit. At approximately 09:35 a.m., LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of pertinent facility documents relevant to the visit. At approx 10:00 a.m. LPA spoke with a home health nurse conducting a visit with Resident #1 (R1). Home health nurse stated they had difficulty getting hold of staff to enter the facility. Interview with R1 confirmed the phone rang multiple times this morning, but staff was busy providing assistance to another resident. LPA interview with four (4) residents in care revealed they were satisfied with the service and food at this time. LPA observed a sufficient supply of perishable and non-perishable food properly stored during today's visit. At approx 11:47 a.m. LPA observed Administrator bring in extra groceries and specific items requested by residents. Administrator also arrived with a reliever staff who was fully cleared and associated to the facility. LPA's review of California Department of Social Services criminal clearance record database revealed that staff #1 (S1) is not fingerprint cleared to work. Interviews and records review confirmed that S1 started working at this facility today. Following deficiencies were cited from the Title 22 California Code of Regulations on 809-D. Civil penalty issued today in the amount of $1,100 for staff not finger print cleared and a repeat violation. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted, appeal rights discussed and a copy of report provided.the state’s words, verbatim · CDSS document, Sep 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Sep 24, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on observation, interview and record review, the Licensee did not comply with section cited above as S1 is not fingerprint cleared, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Administrator obtained reliever for S1 to cover shift .Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 09/24/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87615(a)(1) · Plan of correction due date: Sep 24, 2025

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:(1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on interviews and record review, the Licensee did not comply with section cited above as R1 has a stage 3 wound on their left ankle, and R4 has a stage 4 wound on hip, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Administrator agreed to relocate R1 and provide proof to LPA. Administrator also agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 09/24/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 3, 2025

(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 evidence by Based on observation the licensee did not comply with section cited above as LPA observed multiple dirty dishes on the counter, left over food on dining table and flies hovering in the kitchen, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Staff cleaned kitchen during the visit. Administrator agreed to review section cited and create a plan on how they will ensure to keep future compliance the send to LPA via email COB 10/03/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(a) · Plan of correction due date: Oct 3, 2025

Facility personnel shall at all times be sufficient in numbers...the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as staff was unable to be readily availble to open the door for a home health nurse as staff was assisting a resident, which poses a potential health, safety or personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/03/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d) · Plan of correction due date: Sep 24, 2025

(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as the Administrator did not demonstrate sufficient knowledge of new staff and new resident, which poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 09/24/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(g) · Plan of correction due date: Oct 3, 2025

87412(g) - All personnel records shall be maintained at the facility. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as S1 did not have a complete file onsite for review, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/03/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87609(b)(4)(A) · Plan of correction due date: Oct 3, 2025

(4) The licensee and home health agency agree in writing on the responsibilities...(A)The written agreement shall reflect the services, frequency and duration of care. This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as R1, R2, R3 are on homehealth, but there were no records onsite available to review, which poses a postential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/03/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Oct 3, 2025

(1)A written report shall be submitted to the licensing agency and to the person responsible... (A) through (D) below... attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Based on records review, facility has not submitted any incident reports or death reports, which poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/03/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Oct 3, 2025

Prior to admission a determination of the prospective resident's suitability for admission... with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement was not met as evidenced by: Based on records review LPA did not observe any pre-admission documentation on site for review for R4, which poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 23, 2025

Plan of correction: Administrator agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email COB 10/03/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Zabel Chochian conducted a Case Management - Deficiencies. LPA met with individual/staff Kristine Mesropyan. Staff attempted to contact Administrator Lala Soghomonyan. At approximately 11am, LPA toured the facility with staff and met with three residents. All three residents interviewed expressed being satisfied with the service and food. LPA observed a sufficient supply of perishable and non-perishable food properly stored during today's visit. At approximately 12:15pm, LPA spoke with Administrator Lala Soghomonyan and the reason for the visit was discussed. Administrator stated that she is at least 3hrs away from the facility and is unable to come to the facility. LPA requested that Administrator contact Owner/operator Sarkis Dovlatyan to inform him of LPA's visit and see if he would be able to come to the facility. At approximately 12:40pm, LPA received a call back from Administrator stating that she was unable to reach Mr. Sarkis Dovlatyan. At approximately 1:15pm, LPA and Licensing Program Manager Desaree Perera spoke with Mr. Sarkis Dovlatyan and explained the reason for the visit today. California Department of Social Services criminal clearance record database was reviewed and learned that staff #1 is not fingerprint cleared to work and has been working at the facility without a criminal record clearance. Interviews and records review confirmed that staff #1 has been working at the facility since 08/31/2025. During todays visit, interview and records review revealed that staff #2, hired since 9/6/2025 completed a request for live-scan however facility did not receive a criminal record clearance for the staff prior to staff being present at the facility as a caregiver since 9/6/2025-9/10/2025. Administrator came to the facility with reliever staff to cover shift and removed staff #2 from the facility during today's visit pending criminal record clearance. An updated LIC 500 showing 24/7 staff coverage schedule was obtained. Following deficiency was cited from the Title 22 California Code of Regulations. Civil penalty issued today for facility staff not having fingerprint clearance. Exit interview held. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 10, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Sep 10, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on observation, interview and record review, the Licensee did not comply with section cited above as Staff #1 and Staff #2 are not fingerprint cleared and in pending status. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 10, 2025

Plan of correction: Licensee and Administrator obtained reliever for staff #2 to cover shift pending fingerprint clearance. Also licensee understands that staff #1 cannot return to work pending fingerprint clearance. Licensee and Administrator provided an updated LIC 500 during today's visit. Civil Penalty in the amount of $1100 is assessed today for fingerprint clearance for staff #1 and $500 for staff #2. Total civil penalty is $1600.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced case management visit - other to ensure the health and safety of the residents in care. Upon arrival LPA met with staff and explained the reason for the visit. Administrator was contacted and stated they would be at facility in approx (1) hour. Licensee was contacted, but stated they were unable to be present at facility. At approx 10:10 a.m. LPA conducted physical plant and interviewed residents. LPA observed a sufficient supply of perishable and non-perishable food properly stored at this time.LPA Interviewed Administrator over the phone. Interview revealed Resident #2(R2) was admitted into hospital on Sunday afternoon. Administrator stated they will provide incident report by end of the day. At approx 11am LPA followed up with Administrator regarding their ETA and Administrator stated they ran into a delay, but could be at the home in approx 2 hours. LPA contacted Licensee who stated that staff Margarita Dovlatyan will sign in their place. Interviews with residents revealed they have been provided with sufficient meals and snacks since LPA's last visit on 09/04/2025. In addition, residents did not express any concerns at this time. During the visit, LPA did not observe any immediate health and safety concerns at this time.the state’s words, verbatim · CDSS document, Sep 8, 2025

Allegation investigated: Staff did not ensure facility is free from pests Staff do not ensure window screen are in good repair Staff did not ensure cleaning supplies were inaccessible to residents Administrator is not at the facility for the required amount of time Administrator did not designate a qualified staff while administrator out of the country Administrator does not return ombudsman calls Staff do not ensure facility has the required amount of food to meet residents needs

**This is the amended report to update information. The intial report was delivered 08/19/2025*** Licensing Program Analysts (LPAs) Brian Balisi, Martha Arroyo along with Licensing Program Manager (LPM) Desaree Perera conducted an unannounced complaint visit to investigate allegations listed above. Upon arrival LPAs and LPM met with with Staff and explained the reason for the visit. Administrator Lala Soghomonyan arrived shortly after. At approx 10:00am, LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that "Staff did not ensure facility is free from pests" as it was alleged that flies were observed in the kitchen, common area, residents bedrooms and hallways. Interviews conducted revealed three (3) out of Three (3) residents have observed flies throughout the facility. Substantiated Continued from 9099 During physical plant LPA observed flies hovering over food debris on the dining table and the kitchen countertop. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Staff did not ensure facility is free from pests" has been deemed Substantiated at this time. It was reported that "Staff do not ensure window screen(s) are in good repair" as it was alleged that a window screen was observed not secure and torn. During physical plant, LPA observed screen in bedroom #1 to be in disrepair. The room was not occupied at this time. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that " Staff do not ensure window screen(s) are in good repair " has been deemed Substantiated at this time. It was reported that "Staff did not ensure cleaning supplies were inaccessible to residents" as it was alleged that cleaning supplies were observed in the bath area making it difficult for residents to shower. During the visit, LPA observed multiple cleaning supplies stored underneath the kitchen sink not locked and accessible to residents in care. Interviews conducted with three (3) out of (3) residents in care revealed that (2) of the residents who use the facility shower have not observed any cleaning supplies stored in the bathroom at this time. One (1) of the residents interviewed stated that a nurse visits at least twice a week to provide bed baths so they do not make use of the facility shower at this time. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Staff did not ensure cleaning supplies were inaccessible to residents" has been deemed Substantiated at this time. It was reported that "Administrator is not at the facility for the required amount of time, Administrator does not return ombudsman calls and Administrator did not designate a qualified staff while administrator was out of the country" Interview conducted with (3) three out of (3) residents in care revealed they all have observed the Administrator visit the facility at least once a week and at most twice during the week. They do not recall a time when the Administrator did not visit the facility for a prolonged period of time.Before today's visit, LPA conducted visits to this facility on the following dates: 06/06/2025, 06/16/2025, 06/23/2025 and 07/10/2025 and was not able to meet with the Administrator. LPA spoke with Licensee Sarkis Dovaltyan who stated that they were not aware of any third party agencies attempting to contact the Administrator, but for any pressing concerns staff would typically inform Sovaltyan if immediate assistance was required. Continued from 9099-C During today's visit, at approx. 10:00 a.m. LPA spoke with Administrator Lala Soghomonyan who stated they would meet the LPA on site. LPA attempted to follow up with Lala at approximately 11:30 a.m. but they stated they were unable to make the visit due to a family emergency. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Administrator is not at the facility for the required amount of time, Administrator does not return ombudsman calls and Administrator did not designate a qualified staff while administrator was out of the country" has been deemed Substantiated at this time. It was reported that "Staff do not ensure facility has the required amount of food to meet residents needs" as it was alleged that there was not a variety of food, there was not a sufficient supply of food and the food that was observed was not stored properly. Interviews conducted with three (3) out of (3) residents in care revealed all (3) did not express any concerns with the taste, the amount or the type of foods and snacks that were observed however, all (3) expressed that they would prefer more fruits and vegetables offered. During the visit LPA observed a sufficient amount of perishable and non-perishable food properly stored. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Staff do not ensure facility has the required amount of food to meet residents needs" has been deemed Substantiated at this time. The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided Continued from 9099 Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the 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 above allegation “Staff do not ensure a telephone is available to residents” is deemed Unsubstantiated at this time. It was reported that "Staff do not ensure facility is clean" as it was alleged that floors are not cleaned and plates, cups and silverware are dirty. Interviews conducted with three (3) out of (3) residents in care revealed they observed staff throughout their shift. All (3) stated they do not recall seeing any dirty utensils when eating and all (3) did not express any concerns for staff not ensuring facility is kept cleaned. During the visit, LPA observed staff mopping floors and cleaning the bathroom. LPA observed all utensils and dishware store in the cabinets to clean at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the 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 above allegation “Staff do not ensure facility is clean” is deemed Unsubstantiated at this time. It was reported that "Staff store durable medical equipment in the bathroom / tub resulting in residents not being able to shower easily" as it was alleged that toilet frames were kept in the shower area making it difficult for residents to shower. Interviews conducted with three (3) residents in care revealed two (2) out of (3) residents have observed the equipment stored in the area, however both stated that staff moved it out of the way when they shower and both did not express any concerns for their accessibility to shower at this time. One (1) resident stated that nurse visits them twice a week to bathe them in bed. This resident has never used the hallway bathroom to shower. LPA’s interview with staff revealed that when residents request to shower they move the equipment out of the way. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the 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 above allegation “Staff store durable medical equipment in the bathroom / tub resulting in residents not being able to shower easily” is deemed Unsubstantiated at this time Continued from 9099-C It was reported that "Staff did not ensure facility was kept at a comfortable temperature for residents" as it was alleged that it was observed that the outside temperature was over 90 degrees and the inside of the facility felt warm. Interviews conducted with three (3) out of (3) residents in care revealed that all (3) did not express any concerns for the temperature of the home since they have resided here. Furthermore, all (3) stated they do not recall when the facility felt too hot. During the visit, LPA observed the outside temperature to be 88 degrees with the thermostat set to 74 degrees. LPA did not observe it to be uncomfortable inside the facility. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the 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 above allegation “Staff did not ensure facility was kept at a comfortable temperature” is deemed Unsubstantiated at this time Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Sep 4, 2025 · control 29-AS-20250811102049

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Sep 4, 2025

Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions... in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: Based on LPA's observation, the licensee did not comply with the section cited above as cleaning supplies were observed accessible to residents in care which posed an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Licensee agreed to purchase new lock and install on cabinet underneath the sink provide proof to LPA via email by COB 08/20/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Sep 4, 2025

All facilities shall have a qualified and currently certified administrator...in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement was not met as evidenced by: Based on LPA’s interviews and observations, the licensee did not comply with the section cited above as Adm was not availible in the facility for a sufficient amount of time which posed an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Licensee agreed to review reg cited and submit a statement of understanding, along with a written plan to ensure that an Administrator is present at the facility for a sufficient number of hours. The Licensee also agrees to submit the requested documents, including an updated LIC 500, to LPA via email by COB 08/20/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(c) · Plan of correction due date: Sep 4, 2025

Maintenance and operation - All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Based on LPA observation, the Licensee did not comply in the section cited above as window screens were observed in disrepair which posed a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Licensee agreed to replace or repair window screen and provide proof to LPA via email by COB 08/29/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Sep 4, 2025

The total daily diet shall be of the quality and in the quantity necessary to meet the needs... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by: Based on interviews the licensee did not comply with section above as residents express concerns for lack of fresh produce offered which posed a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Licensee agreed to purchase more produce when grocery shopping. Licensee also agreed to review section cited and provide written plan on how they will ensure future complaince.and provide document to LPA via email by COB 08/29/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Sep 4, 2025

All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Based on LPA observation, the Licensee did not comply in the section cited as insects were observed throughout the facility which posed a potential health, safety personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Licensee agreed to ensure that all surfaces used for food preparation are kept clean, free of debris, and equipped with devices or items designed to prevent pest infestation. The Administrator will also provide photographs of these devices to the LPA via email by COB 08/29/2025

Allegation investigated: Facility retained resident with a prohibited health condition. Staff handle residents in an aggressive manner. Staff does not ensure that resident is being provided an adequate amount of food while in care. Staff does not ensure resident's bathing needs are being met. Staff does not ensure resident's incontinent needs are met.

Licensing Program Analysts (LPAs) Brian Balisi, Martha Arroyo along with Licensing Program Manager (LPM) Desaree Perera conducted an unannounced subsequent complaint visit to this facility in conjunction with an Annual Continuation visit. Upon arrival, LPAs and LPM met with staff Jesusito “Jay” Banawa. The administrator, Lala Soghomonyan, arrived shortly after. The reason for the visit was explained. Entrance interview conducted. On 06/27/2025, LPA Balisi conducted an unannounced initial complaint visit. During the visit, LPA met with licensee Sarkis Dovlatyan. During the visit, at approx. 12:50 p.m. LPA conducted a tour of the physical plant, interviewed staff, resident, reviewed and obtained copies of pertinent documentation relevant to the investigation. Report continued on LIC 9099... Substantiated Report Continued from LIC 9099... During today’s visit, LPAs and LPM conducted a tour of the physical plant, interviewed residents, staff, administrator and licensee between 9:40 a.m. – 12:00 p.m. Additionally, LPAs reviewed and obtained documents related to the investigation. It was alleged that the “facility retained a resident with prohibited health conditions”. It was further reported that Resident #1 (R1) had multiple sores on R1s arms, buttocks and legs including an open sore. During the investigation, LPA requested the facility file for R1, however, the administrator was unable to provide any documentation pertaining to R1. However, during today’s visit, LPAs and LPM observed Resident #2 (R2) at the facility with a prohibited health condition. LPAs and LPM interview with administrator reflected that R2 does not have any Home Health (HH) services at this time. Per staff, R2 will be evaluated for hospices services. Based on the information gathered during the course of the investigation, the Department has sufficient evidence to determine the “facility retained a resident with prohibited health condition,” therefore, the above allegation is deemed SUBSTANTIATED at this time. It was alleged that “Staff #1 (S1) treats residents in an aggressive manner”. It was reported that S1 yells, hits and treats residents in an aggressive manner. Interviews conducted during the course of the investigation reflected that S1 did in fact treat residents in an aggressive manner. S1 would yell, and did not allow residents to speak with each other, leave their bedrooms or eat outside. Interviews further reflected that S1 was also seeing hitting resident however, no injuries were noted. Based on information gathered during the course of the investigation, the Department has sufficient evidence to determine S1 treated residents in an aggressive manner, therefore, the above allegation “Staff #1 (S1) treats residents in an aggressive manner” is deemed SUBSTANTIATED at this time. It was also alleged “Staff does not ensure that resident is being provided an adequate amount of food while in care.” Information gathered during the course of investigation reflected residents were only receiving one meal until approximately 2 days ago. Furthermore, during today’s visit, LPAs and LPM did not observe a sufficient amount of perishable and non-perishable food available to the residents. Additionally, during today’s visit, at approximately 1:00 p.m., LPAs and LPM did not observe staff preparing lunch for residents. Report Continued on LIC 9099C... Report Continued from LIC 9099C... The administrator nor staff were unable to respond as to why lunch was not being prepared and what was on the menu for lunch. LPM requested that the administrator prepare lunch for all residents immediately. Based on all information gathered during the course of the investigation, the Department has sufficient evidence to determine that staff did not provide an adequate amount of food for residents. Therefore, the above allegation “Staff does not ensure that resident is being provided an adequate amount of food while in care” is deemed SUBSTANTIATED at this time. It was alleged that “Staff does not ensure resident's bathing needs are being met.” It was reported that staff did not assist R1 with showers. During the course of the investigation, LPA was unable to speak to R1 due to R1 no longer residing in the facility. However, during interviews conducted during today’s visit, it was determined that Resident #3 (R3) was not showered for a prolonged period of time. Interviews further reflected that the facility staff does not assist R3 with showers, toileting, or grooming and R3 only receives showers from HH twice a week. Based on the information gathered, the Department has sufficient to determine that residents are not receiving basic services such as bathing or grooming. Therefore, the above allegation, “Staff does not ensure resident's bathing needs are being met” is deemed SUBSTANTIATED at this time. It was also alleged that “Staff does not ensure resident's incontinent needs are met” as residents were being left soiled for an extended period of time. During today’s visit, LPAs and LPM did not observe any residents who currently use diapers. However, LPAs and LPM were informed that R3 has an indwelling urinary catheter and staff empty the bag without appropriate training from a skilled professional. Furthermore, it was reflected that R3 has had numerous UTIs due to the catheter not properly being cared for. Moreover, staff were unaware of who to contact or who provided R3 assistance with the catheter care. Based on the information gathered during the course of the investigation, the Department has sufficient evidence to determine residents did not receive proper incontinent care. Therefore, the above allegation, “Staff does not ensure resident's incontinent needs are met” is deemed SUBSTANTIATED at this time. Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC9099-D). Additional citations observed during this complaint investigation was cited on the Annual continuation visit. Exit interview conducted, appeal rights discussed, and a copy of this report issued.the state’s words, verbatim · CDSS document, Sep 4, 2025 · control 29-AS-20250625100817

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87631(a)(1) · Plan of correction due date: Sep 5, 2025

(a)Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: (1) When care is performed by or under the supervision of an appropriately skilled professional. This requirement is not met as evidenced by: Based on interviews and observations, licensee did not comply with the section above by retaining a resident (R2) with pressure injuries with no appropriately skilled professional providing care to the sore, which poses an immediate health, and safety risk to resident in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Administrator agreed to review regulation cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 09/05/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(3) · Plan of correction due date: Sep 5, 2025

(f) Basic services shall at a minimum include: (3) Three nutritionally well-balanced meals and snacks made available daily, including low salt or other modified diets prescribed by a doctor as a medical necessity, as specified in Section 87555, General Food Service Requirements. This requirement is not met as evidenced by: Based on observation and interviews, licensee did not comply with the above section due to residents only receiving one (1) meal for a period of time, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Administrator agreed to review regulation cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 09/05/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Sep 5, 2025

(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement is not met as evidenced by: Based on interviews, licensee did not comply with the above section by not providing residents basic services such as bathing and grooming which poses a immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Administrator agreed to review regulation cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 09/05/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87623(b)(1) · Plan of correction due date: Sep 5, 2025

b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (1) Ensuring that insertion and irrigation of the catheter shall be performed by an appropriately skilled professional.…This requirement is not met as evidenced by: Based on interviews and record review, licensee did not comply with the section above by not ensuring an appropriately skilled professional provided care to R3s catheter, which poses an immediate health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Administrator agreed to review regulation cited and submit a statement of understanding, along with a written plan to ensure future complaince and send to LPA via email by COB 09/05/2025.

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA)s Brian Balisi, Martha Arroyo along with Licensing Program Manager (LPM) Desaree Perera arrived at the facility unannounced to conduct an annual continuation visit. LPA's and LPM met with staff and explained the reason for the visit. Administrator arrived shortly after. At approx. 09:35 a.m. , LPA's and LPM conducted physical plant. The following was observed: At approx 09:45 a.m., LPA's and LPM observed Resident #1 (R1) assisting Resident #2(R2) to the restroom. Staff #1 (S1) stated R1 assists S1 with R2 due to S1 being the only one on shift since Sunday 08/31/2025. At approx 09:56 a.m., LPA's and LPM observed insulin stored in the fridge accessible to residents in care. At approx 10:00 a.m. LPA's and LPM observed Medications stored in Resident #3 (R3)'s room. At approx 10:15 a.m. LPA's and LPM observed S1 administering insulin to R2. At approx 10:44 a.m., LPA"s and LPM did not observe a sufficient amount of perishable and non-perishable food store in the fridge or the pantry closet by the front door. At approx 10:45 a.m. LPA's and LPM did not observe a sufficient amount of PPE. Continued from 809 The backyard has a covered outdoor area equipped with furniture including a table and chairs for resident use. The property is gated with a motorized gate leading into driveway. There is an entry way gate for client use and is single latched. No bodies of water noted at this time. There is an Adult Dwelling Unit located in the rear of the facility. A certificate of Occupancy was observed approved as of 08/14/2025. The family of Licensee was observed occupying the ADU at this time. Records review, four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. The following was observed: At approx 10:45 a.m. (3) out of (4) residents did not have a preplacement appraisal, (2) out of (4) residents did not have a current medical assessment, (3) out of (4) residents did not have a complete admissions agreement, Three (3) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. At approx 01:07 p.m. Administrator and current staff did not have any training documents on file. A complete first aid kit was not observed onsite. At approx 01:40 p.m. LPA's were unable to conduct Medications review due to facility not having update centrally stored medication lists for residents in care. At approx 02:05 p.m. LPA's observed a bottle of bleach and gardening tools in the backyard accessible to residents in care. At approx 02:50 p.m. Last emergency disaster drill conducted could not be confirmed and Limited liability insurance not available for review. Continued from 809-C Infection control: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of a communicable disease. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of an infectious disease. The facility was instructed to obtain additional PPE. The LPA requested the following documents at the time of visit: LIC500 Personnel Report, LIC9020 Client Roster, and a copy of the facility’s liability insurance. Interviews were conducted during the visit. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were providedthe state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced 10-day complaint visit to the facility regarding the above noted allegations. At 11:28 A.M., caretaker Jesusito ”J” Banawa who contacted administrator via phone. At 3:02 P.M. the administrator, Lala Soghomonyan arrived at the facility with administrator assistant Yeva Vartine. LPA explained the purpose of the visit. At 4:45 P.M. Sarkis Dovlatyan joined the visit. Entrance interview conducted. During today's inspection, between 11:30 A.M. and 3:50 P.M., the LPA briefly toured the facility with the caretaker. LPA interviewed staff and four (4) residents and obtained copies of pertinent documents relevant to the investigation. During the course of the investigation LPA requested all four (4) resident's files. Records revealed that all four (4) residents in care did not have a pre-appraisal assessments, physician's reports, admission agreements, personal right and consent forms completed in their file, Administrator was not able to provide such documents during today's visit. The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. An immediate $250 civil penalty issued today for a repeat violation. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 2, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Sep 18, 2025

Prior to admission a determination of the prospective resident's suitability... comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement was not met as evidence by: Based on interviews and records review the licensee did not ensure a onboarding documentation was completed or onsite for four (4) out of four (4) residents in care which poses a potential personal rights and health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2025

Plan of correction: Licensee agreed to review section cited, keep full facility file and create a written plan on how they will ensure future compliance then send to LPA via email by COB 07/18/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA met with Administrator Lala Soghomonyan and explained the reason for the visit. LPA toured the physical plant areas to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. LPA inspected the kitchen/food service area at approx. 3pm. Sharp objects are stored in a locked drawer to the right of the dishwasher. Medication is stored in a locked cabinet above the dishwasher. The facility has a sufficient supply of perishable and non-perishable food properly stored at this time. At the time of the visit, the common area furniture's were observed to be in good condition. The facility maintained a comfortable temperature of 72 degrees Fahrenheit. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. LPA observed fire extinguisher to be fully charged and last purchased on 07/25/2024. Administrator stated they will purchase a new one by end of the week. LPA observed three (3) resident bedrooms , which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. The resident bathroom was clean, sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured between 105 - 120 degrees Fahrenheit. Due to time constraints, LPA will return at a later date for a continuation inspection visit. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Jul 21, 2025

Allegation investigated: Licensee does not ensure that resident is being provided an adequate amount of food while in care. Staff are unable to communicate with resident in care due to language barrier.

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent unannounced complaint visit to deliver findings. Upon arrival LPA met with staff and explained the reason for the visit. Licensee Sarkis Dovlatyan and Assistant Administrator Iveta Darabedym were all contacted and each stated they were unable to be onsite for the visit due to unforseen circumstances. Administrator Lala Soghomonyan was out of town during the visit. Licensee and Assistant Admin stated staff Tamara Borisovna could sign in their place. On 12/12/2024, the initial complaint visit was conducted by LPA between approximately 10:00 a.m. - 11:30 a.m. During the visit, LPA’s conducted physical plant, interviewed staff, residents as well as reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that "Licensee does not ensure that resident is being provided an adequate amount of food while in care" , as it was alleged that Resident #1 (R1), did not get enough food and did not have a variety of food while they resided at the facility. Unsubstantiated Interviews conducted with one (1) out of three (3) residents in care revealed that they are satisfied with the food they receive because of the variety, which included soup, sandwiches, burgers, tacos and rice plates. (1) resident did not want to interview and the other resident was sleeping at the time of the visit. LPA's interview with staff revealed typical meals include Oatmeal with fresh fruit and toast for breakfast, hot dog, sandwiches, tacos, burgers, soup, chicken , sauteed vegetables for lunch and dinner. A family member of R1 would also visit approximately once a week and provide specific foods that R1 requested and staff would cook it for R1. Staff continued to state that R1 never missed a meal while they resided at the home. During physical plant, LPA observed a sufficient amount of perishable and non-perishable food properly stored. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the 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 above allegation “licensee does not ensure that resident is being provided an adequate amount of food while in care” is deemed Unsubstantiated at this time. It was reported that "Staff are unable to communicate with resident in care due to language barrier " as It was alleged that facility staff had difficulty communicating with R1 while they resided at the facility because R1 primarily speaks Spanish. Interviews with the complainant and facility staff indicated that R1 spoke limited English but communicated most effectively in Spanish. R1 was able to follow simple instructions and express some needs. Additionally staff stated they were able to communicate with R1, to inform them when meals were ready, check on their well-being, or ask if they needed help. Staff made use of a translation app only to have conversations with R1. Staff did not recall R1 raising any immediate or potential concerns during their time at the facility. During interviews, one of the three residents interviewed stated they had no issues communicating with R1. One (1) resident declined to be interviewed and the other resident was sleeping. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the 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 above allegation “Staff are unable to communicate with resident in care due to language barrier” is deemed Unsubstantiated at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 29-AS-20241206160956

Allegation investigated: Staff does not ensure an appropriately Skilled Professional administers Glucose Testing and Insulin to resident Staff is not competent to meet the needs of residents Due to staff negligence, resident missed medications resulting in high blood sugar Staff did not do a proper assessment of resident Staff did not properly safeguard the residents medications Licensee retained resident who is bedridden in a room without bedridden fire clearance

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint visit to investigate the allegations listed above. Upon arrival LPA met with staff and explained the reason for the visit. Licensee Sarkis Dovlatyan and Assistant Administrator Iveta Darabedym were all contacted and each stated they were unable to be onsite for the visit due to unforseen circumstances. Administrator Lala Soghomonyan was out of town during the visit. Licensee and Assistant Admin stated staff Tamara Borisovna could sign in their place. At approx 10:00a.m. LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of pertinent documentaiton relevant to the investigation. It was reported that "Staff does not ensure an appropriately skilled professional administers Glucose Testing and insulin to resident" and "Due to staff negligence, resident missed medications resulting in high blood sugar" as it was alleged that Resident #1 (R1) has resided at this facility for approx twelve (12) days and has not been administered insulin or Glucose testing. Substantiated Interviews with Staff and Assistant Administrator confirmed that the insulin was never obtained and Glucose testing was not conducted. R1's file was not on site for review. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Staff does not ensure an appropriately skilled professional administers Glucose Testing and insulin to resident" and "Due to staff negligence, resident missed medications resulting in high blood sugar" has been deemed Substantiated at this time. It was reported that "Staff is not competent to meet the needs of residents" as it was alleged that staff are unable to communicate effectively with residents and outside agencies. LPA's interview with three (3) out of five (5) residents in care revealed they could communicate their basic needs to Staff #1 (S1), however they could communicate more effectively with use of a translation app. (1) resident declined to be interviewed and another resident was in the hospital. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Staff is not competent to meet the needs of residents" has been deemed Substantiated at this time. It was reported that "Staff did not do a proper assessment of resident" as it was alleged that Licensee was unaware who conducted pre-appraisal assessment of R1. LPA's records review of resident records revealed two (2) out of five (5) residents in care did not have a pre-appraisal assessment completed in their file. Interview with Assistant Administrator revealed that an assessment was completed , but staff onsite could not locate R1's records for review. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Staff did not do a proper assessment of resident " has been deemed Substantiated at this time. During the complaint visit ,It was observed that "Staff did not properly safeguard the resident's medications" ,during physical plant and interviews with residents, LPA observed multiple prescribed medication stored and easily accessible in the rooms of Resident #2 (R2) and Resident #3 (R3). Interviews with R2 and R3 revealed they prefer to store it with them. Residents were advised of Title 22 regulations regarding the storage of medications. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Staff did not properly safeguard the residents medications " has been deemed Substantiated at this time. Continued from 9099-C During complaint visit it was observed that "Licensee retained resident who is bedridden in a room without bedridden fire clearance" as LPA's records review revealed Resident #4 (R4) was admitted to the facility and is listed as bedridden. Records review of facility file revealed only Bedroom #3 is cleared for bedridden residents and R4 is located in bedroom #1, which has no direct exit to the outside. Based on information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that "Licensee retained resident who is bedridden in a room without bedridden fire clearance " has been deemed Substantiated at this time. The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. An immediate $500 civil penalty issued today for fire clearance violation. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 29-AS-20250709155231

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87629(b)(1) · Plan of correction due date: Jul 11, 2025

Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement was not met as evidenced by: Based on interviews and records review, the Licensee did not comply with the section cited above as R1 has not received glucose testing or insulin, which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Licensee agreed to review section cited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to LPA via email by COB 07/11/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Jul 11, 2025

Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on interviews , the Licensee did not comply with the section cited above as R1 has not been receiving their insulin injections, which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Licensee agreed to review section cited and provide a statement of understanding along with a written plan on how they will ensure future compliance then submit to LPA via email by COB 07/11/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jul 11, 2025

(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement has not been met as evidenced by: Based on observation and interviews the Licensee did not comply with the section cited above as R2 and R3 stored their prescribed medications in their room, which poses an immediate health, safety and personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Licensee instructed staff to relocate medication into centrally stored location. Licensee also agreed to review section cited and create a written plan on how they will ensure future compliance then send to LPA via email by COB 07/11/2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Jul 11, 2025

(a)All facilities shall maintain a fire clearance... approved by the city, county, or city and county fire department, or...(2) Bedridden persons. This requirement was not met as evidence by: Based on records review and interviews the Licensee did not comply with the section cited above as R4 is listed as bedridden and resided in a room that did not have fire clearance for bedridden residents which poses an immediate health and safety to residents in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Licensee agreed to immediately relocate R4 to a room that has appropriate fire clearance and review section cited, submit a statement of understanding and proof of R4's relocation to LPA by COB 07/11/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Jul 18, 2025

To have a reasonable level of personal privacy in accommodations... communications, telephone, conversations... meetings of resident and family groups. This requirement was not met as evidence by: Based on interviews and observations, the licensee did not ensure there was staff scheduled who can communicate with residents in a language they can fluently communicate in, which poses a potential personal rights and health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Licensee agreed to provide an updated LIC 500, and agreed to review section cited and ensure to have staff scheduled that can communicate with residents in care and outside agencies. Licensee also agreed to submit statement of understanding via email to CCL by COB 07/18/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Jul 18, 2025

Prior to admission a determination of the prospective resident's suitability... comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement was not met as evidence by: Based on interviews and records review the licensee did not ensure a pre-appraisal was completed or onsite for (3) out of (5) residents in care which poses a potential personal rights and health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Licensee agreed to review section cited, keep full facility file and create a written plan on how they will ensure future compliance then send to LPA via email by COB 07/18/2025.

Allegation investigated: Staff did not ensure residents repsonsible party received pro-rated refund

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to deliver final findings for the allegation listed above. Upon arrival LPA met with staff and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after. On 10/18/2024, the initial complaint visit was conducted by LPA between approximately 09:45 a.m. - 02:00 p.m. During the visit, LPA conducted a tour of the physical plant, medication audit, interviewed staff as well as, reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that "Staff did not ensure residents responsible party received pro-rated refund" as it was alleged that the family of Resident #1 (R1) had not received a refund check in the amount of $850 in a timely manner, after R1 no longer resided at the facility. Interviews conducted with Administrator revealed they stated they had already generated a refund check but they were not able to provide proof of check during the initial visit. Substantiated Continued from 9099 LPAs interview with family member of R1 after the initial visit on 10/18/2024 revealed R1 had resided at the facility for approx (3) months. R1 was relocated out of the facility on 06/18/2024 and the family of R1 picked up R1's belongings on 06/20/2024. They were told they would receive a pro-rated refund check within a week. But as of 10/18/2024 they had yet to receive the check. On 10/25/2024, LPA interviewed family member of R1 who stated they had just received the check in the amount of $850 on 10/23/2024. Based on information obtained during the investigation, the department has sufficient evidence to determine this allegation occurred. Therefore, the above allegation “Staff did not ensure residents responsible party received pro-rated refund" is deemed substantiated at this time. The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were providedthe state’s words, verbatim · CDSS document, Jun 27, 2025 · control 29-AS-20241014112146

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Jul 7, 2025

Health&Safety§1569.652(c)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...resident’s estate, within 15 days after the personal property is removed.This requirement is not met as evidenced by Based on interview and record review, the Licensee did not comply with the section cited above, as a refund check was not provided to family of R1upon relocating from facility, which poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 27, 2025

Plan of correction: On 10/25/2024, family of R1 confirmed to LPA they had received a check for the amount of $850 from the facility covering the refund due. Licensee also agreed to review section cited and submit a statement of understanding to ensure future compliance then send to LPA via email by COB 7/7/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Martha Arroyo conducted a Case Management - Deficiencies visit to address deficiencies observed during an unrelated complaint investigation. Entrance interview conducted. During today’s visit, interviews revealed that Staff #1 (S1) has been employed at the facility for approximately one (1) month. The LPA reviewed the facility's Guardian roster and discovered that S1 does not have fingerprint background clearance and is not associated with the facility. The Licensee was informed that S1 must obtain fingerprint clearance and be properly associated with the facility prior to beginning employment. Relieving staff that is cleared arrived to provide the care and supervision of all residents, and S1 left the premises. Additionally, the LPA attempted to review Resident #1’s (R1’s) file; however, it was not available or accessible at the facility during today’s visit. The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. An immediate $500 civil penalty issued today for facility staff not having fingerprint clearance. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jun 23, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with section cited above as S1 is not fingerprint cleared or associated to the facility, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 23, 2025

Plan of correction: The Licensee has agreed to create and submit a staffing plan and updated LIC 500 and send to CCL no later than 06/27/2025. Civil Penalty in the amount of $500 assesed today for fingerprint clearance.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(a) · Plan of correction due date: Jun 27, 2025

(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 as evidenced by: Based on record review and interviews, the Licensee did not comply with the section cited above as file for R1 was unavailable at the facility for review, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 23, 2025

Plan of correction: The Licensee has agreed to create and submit a plan on how the facility will ensure resident files are complete and maintained at the facility and send to CCL no later than 06/27/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Brian Balisi conducted a Case Management - Deficiencies visit in conjunction with the complaint visit (Complaint Control #29-AS-20250611092348). Reason for this report is to issue deficiency observed during the complaint investigation which were unrelated to the complaint allegation. During today’s visit, LPA met with Licensee Sarkis Dovlatyan and explained the reason for the visit. During records review, LPA did not observe a full resident file completed for Resident #1 (R1). The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 16, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Jun 20, 2025

(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 was not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as a full record was not found in R1's file, which poses a potential health, safety and personal rights risk to residents to care.the state’s words, verbatim · CDSS document, Jun 16, 2025

Plan of correction: Licensee agreed to keep full facility file and will create a written plan on how they will comply with the regulation cited moving forward and send plan to LPA via email by COB 06/20/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Brian Balisi and Trevor Byrne conducted an unannounced Case Management - Deficiencies visit. LPA's were joined by LA fire inspector Benjamin Guzman. Reason for this report is to issue deficiency observed during the pre-licensing visit for Age Well Assisted Living #195850516. During today’s visit, LPAs met with Administrator Lala Soghomonyan and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after. The following was observed: At approx 10:00a.m, the structure in the rear of the facility was observed to be occupied by the family of Licensee Sarkis Dovlatyan. Inspector Guzman informed Sarkis the structure is not licensed as an Adult Dwelling Unit (ADU) and should not be occupied at this time. Sarkis was advised by Guzman to begin application process with Los Angeles Department of Building Services (LADBS) and for it to be completed by June 1st, 2025. At approx 10:10 a.m. it was observed that the entire property is not completely fenced as there was access to the adjacent structures located on the property. A $500 immediate civil penalty is assessed today for violation of fire clearance. The Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights explained and report issued.the state’s words, verbatim · CDSS document, Jan 24, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jan 27, 2025

All facilities shall maintain a fire clearance approved by the city... or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: Based on physical plant, the licensee did not comply with the section cited above as tenants were occupying an illegal conversion of an ADU, which poses an immediate health, safety and personal rights risk to residents to care.the state’s words, verbatim · CDSS document, Jan 24, 2025

Plan of correction: Licensee agreed to ensure structure is unoccupied and follow instructions provided by LA Fire inspector as well as provide a written plan to LPA via email by COB 01/27/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(d)(2) · Plan of correction due date: Feb 7, 2025

The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.This requirement was not met as evidence by: Based on physical plant the licensee did not comply with the section cited above as residents in care had access to adjacent structures located on the property, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 24, 2025

Plan of correction: Licensee agreed to fence the adjacent structures making them inaccessble to the facility and provide proof of installation via email to LPA by COB 02/07/2025.

Allegation investigated: Staff is unable to effectively communicate with a resident in care Facility staff did not ensure that resident received prescribed medications Staff is not meeting the resident's hygiene need Facility retained a resident that requires a higher level of care

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the allegations listed above. During today’s visit, LPA met with Staff and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after. On 10/12/2023, the initial complaint visit was conducted by LPA between approximately 03:55 p.m. - 04:50 p.m. During the visit, LPA conducted a tour of the physical plant, medication audit, interviewed staff, residents, well as, reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that "Staff is unable to effectively communicate with a resident in care" as it was alleged that staff at the facility are unable to sufficiently communicate in English with residents in care. Interviews conducted with four (4) residents in care at the time of the complaint revealed that they all stated they could only communicate clearly with S1 through use of a translating app on their phone. Substantiated Continued from 9099 The residents did not express any immediate concerns for their health and safety as staff are able to provide basic services, but each did express potential concerns that if there was an emergency that they would not be able to communicate with the emergency personnel. LPAs interview with S1 at the time of the complaint revealed that S1 was able to communicate with LPA without the use of a translating app, but it was limited. S1 stated they would be more comfortable to communicate with LPA with the use of a translating app. While using translating app, S1 was able to communicate regarding facility business and resident care needs however they stated they would contact Elena Kordonskiy in the event of an emergency. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “Staff is unable to effectively communicate with a resident in care” has been Substantiated at this time. It was reported that "Facility staff did not ensure that resident received prescribed medications", as it was alleged that R1 had not received any medication since being admitted into facility. Interviews conducted with S1 revealed they do not recall R1 coming into the facility with any medication at this time. R1 was at the facility for approx. ten (10) days and medication was never provided to S1 to administer to R1. R1 did not have a complete resident file at the facility. Therefore, LPA was unable to ensure medication was provided to R1 per physician's orders. Interviews and records did not reflect that the facility administrator nor staff attempted to contact the hospital R1 was discharged from nor R1’s Primary Care Physician (PCP) therefore, R1 did not receive their prescribed medication while residing at the facility. Based on the information gathered during the investigation, the department has sufficient evidence to determine R1 was not given medication as prescribed. Therefore, the above allegation is deemed Substantiated at this time. It was reported that "Staff is not meeting the resident's hygiene needs" as it was alleged that R1 does not have a toothbrush and toenails were long. Interview conducted with S1, and Assistant Administrator Elena Kordonsky revealed that S1 and Elena have observed R1 brush their own teeth multiple times. In addition, S1 stated they did cut R1's fingernails, however, a podiatrist would have to make a visit to cut R1's toenails. S1 and Elena did not recall how long R1's toenails were at this time. Facility staff had no documentation to support if arrangements were made for a podiatrist to visit R1. Continued from 9099-C Interviews with facility residents also reflected that S1 assists with cutting fingernails but no assistance has been provided regarding setting up regular podiatrist visits. Based on the information gathered, the Department has sufficient evidence to determine that staff did not meet R1’s hygiene/grooming needs. Therefore, the above allegation is deemed substantiated at this time. It was reported that "Facility retained a resident that requires a higher level of care" as it was alleged that facility staff could not properly care for R1. Information gathered during the course of the investigation reflected that the facility did not have any of the required paperwork for R1 including but not limited to the Pre-Admission Appraisal, Needs and Services, and Physicians Report. Therefore, the facility staff were not knowledgeable to provide the services R1 needed upon discharge from the hospital and unable to provide LPA with specific services R1 required. Based on the information obtained, the Department has sufficient evidence to determine that the facility retained a resident that required a higher level of care. Therefore, the above allegation is deemed substantiated at this time. The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided. Interviews conducted with Staff #1 (S1) revealed they recall R1 only residing at the facility for approx. 10 days. During that time R1 was able to walk around facility and S1 does not recall R1 having any pressure injuries on their ankles or knees. LPA's interview with Resident #2 (R2) who shared a room with R1 recalled R1 being able to ambulate around the facility with some assistance from S1. R2 does not recall if they ever observed any bruising on R1's body or how long R1 resided at this facility at this time. LPA attempted to obtain additional information from the Reporting Party (RP) regarding the pressure injuries, however, was not successful. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Facility did not prevent resident from developing pressure injuries while in care", is deemed Unsubstantiated at this time. It was reported that "Facility staff is not feeding a resident in care" as it was alleged that staff are not feeding R1 as it appeared that R1 has lost weight, and the RP was informed by Staff #1 (S1) that R1 does not eat. Interviews conducted with four (4) residents in care at the time of the complaint revealed that all (4) did not express any potential or immediate concerns of not being provided food in a timely manner. LPA's interview with S1 revealed that they do not recall informing R1's family that R1 refuses to eat, however they do recall that R1 would only want to eat at lunch and dinner. In addition, LPA's interview with Resident #2 (R2) who shared a room with R1 revealed they do not recall R1 not being fed in a timely manner at this time. During the physical plant tours, LPA observed a sufficient supply of perishable and non-perishable food properly stored. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Facility staff is not feeding a resident in care", is deemed Unsubstantiated at this time. Licensee was cited on a separate Case Management for violations observed during the investigation. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Dec 30, 2024 · control 29-AS-20231006113147

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Dec 31, 2024

87465(c)(2) Incidental and Medical Care: ....Once ordered by the physician the medication is given according to the physician's directions. This requirement has not been met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above as R1 has not received (3) of their prescribed medications, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: Licensee agreed to review section cited and provide a statement of understanding as well as a plan to ensure how they ensure that residents will be provided medications as prescribed and send to LPA via email by COB 12/31/2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(d) · Plan of correction due date: Dec 31, 2024

A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident... directly or through outside resources. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the above cited section, as staff accepted and retained R1 and did not have any required paperwork on file for R1 which posed a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: Licensee agreed to review section cited and provided statement of understanding along with a plan on how they’ll ensure to maintain full facility files and provide proper care to residents. Licensee will provide statement and plan to LPA via email by COB 12/31/2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Jan 10, 2025

To have a reasonable level of personal privacy in accommodations... communications, telephone, conversations... meetings of resident and family groups. This requirement was not met as evidence by Based on interviews and observations, the licensee did not ensure there was staff scheduled who can communicate with residents in a language they can fluently communicate in, which posed a potential personal rights and health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: POC cleared during the visit. Interviews with S1 revealed they are able to effectively communicate without use of translation app. LIC 500 indicates schedule is sufficiently staff with employees who can effectively communicate at this time.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Jan 10, 2025

(f) Basic services shall at a minimum include:(4) Personal assistance and care as needed by the resident... and assistance...Section 87608, Postural Supports. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the above cited section, as staff did not make any arrangements to have R1’s toenails were appropriately groomed, which posed a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: Licensee agreed to provide vendorized training to all staff on this section. Training will be planned by POC due date; Licensee will submit to CCL the plan to include trainer information and date. Proof of training, including sign in roster will be sent to CCL via email by COB date

Allegation investigated: Facility staff were unable to provide resident medical information to emergency responders. Facility staff are unable to communicate due to language barrier.

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the allegations listed above. During today’s visit, LPA met with Staff and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after. On 11/16/2023, the initial complaint visit was conducted by LPA between approximately 11:30 a.m. - 12:30 p.m. During the visit, LPA’s conducted physical plant, medication audit, interviewed staff, residents, as well as, reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that "Facility staff were unable to provide resident medical information to emergency responders" and "Facility staff are unable to communicate due to language barrier", as it was alleged that Staff were unable to communicate with responders regarding resident medical history or status of resident. Substantiated Continued from 9099 Interviews conducted with Staff #1 (S1) revealed they recall when emergency responders were attempting to obtain information regarding Resident #1 (R1), however S1 stated they were not able to effectively communicate with them via a translation app on their phone and they were unable to get a hold of Licensee Sarkis Dovlatyan and Administrator Assistant Elena Kordonskiy during their visit. Based on information obtained during the investigation, the department has sufficient evidence to determine these allegations occurred. Therefore, the above allegations “Facility staff were unable to provide resident medical information to emergency responders" and "Facility staff are unable to communicate due to language barrier" are deemed SUBSTANTIATED at this time. A Repeat Violation Civil Penalty is assessed in the amount $250.00 for deficiency that was previously cited on 12/30/2024 on Complaint Control # 29-AS-20231006113147. Licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D). During the visit Sarkis Dovlatyan had to leave the facility due to personal reasons, but stated staff can sign in their place. Exit interview conducted, appeal rights discussed, and a copy of report issued. Continued from 9099-A Interviews conducted reflected the current residents have no concerns related to medication management. LPA’s medication audit for residents in care at the time of the complaint revealed that medications were administered as prescribed at this time. However, during medication audit, LPA observed that the facility did not maintain a centrally stored medication log for R1. Therefore, the LPA was unable to ensure if medication was provided per physician's orders for R1 at this time. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Resident medication was expired and not up to date", is deemed Unsubstantiated at this time. Licensee was cited on a separate Case Management for violations observed during the investigation. During the visit Sarkis Dovlatyan had to leave the facility due to personal reasons, but stated staff can sign in their place. Exit interview conducted, appeal rights discussed and copy of report issued.the state’s words, verbatim · CDSS document, Dec 30, 2024 · control 29-AS-20231108131542

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Dec 31, 2024

To have a reasonable level of personal privacy in accommodations... communications, telephone, conversations... meetings of resident and family groups. This requirement was not met as evidence by: Based on interviews and observations, the licensee did not ensure there was staff scheduled who can communicate with residents in a language they can fluently communicate effectively, which posed an immediate personal rights and health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: Licensee agreed to provide updated LIC 500, review section cited and ensure to have staff scheduled that can communicate with residents in care and outside agencies. Licensee also agreed to submit statement of understanding via email to CCL by EOD 12/31/2024

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPA Brian Balisi conducted a Case Management - Deficiencies visit report during the investigation of Complaint Control #29-AS-20231108131542. Reason for this report is to issue deficiency observed during the complaint investigation which were unrelated to the complaint allegation. During today’s visit, LPA met with Staff and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after. During records review, LPA did not observe a Centrally stored medication log in Resident #1’s (R1) and a LIC 624 was not submitted to the Department for R1’s hospitalization on 11/01/2023 A Repeat Violation Civil Penalty is assessed in the amount $250.00 for deficiency that was previously cited on 07/30/2024 on Complaint Control # 29-AS-20230714110246. Licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D). During the visit Sarkis Dovlatyan had to leave the facility due to personal reasons, but stated staff can sign in their place. Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 30, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b)(14) · Plan of correction due date: Jan 10, 2025

Current centrally stored medications as specified in Section 87465, Incidental Medical and Dental Care Services. This requirement was not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as the Department did not receive a LIC 624 for R1’s hospitalization, which posed a potential, health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: Licensee agreed to review section cited and provide a statement of understanding along with a written plan to ensure compliance going forward to LPA via email by COB 01/10/2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Jan 10, 2025

Each licensee shall furnish to the licensing agency such reports...seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include...and disposition of the case. This requirement was not met as evidence by: Based on records review, the licensee did not comply with the section cited above as the Department did not receive a LIC 624 for R1’s hospitalization, which posed a potential, health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: Licensee agreed to review section cited and provide a statement of understanding along with a written plan to ensure compliance going forward to LPA via email by COB 01/10/2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Brian Balisi conducted a Case Management - Deficiencies visit in conjunction with the complaint visit (Complaint Control #29-AS-20231006113147). Reason for this report is to issue deficiency observed during the complaint investigation which were unrelated to the complaint allegation. During today’s visit, LPA met with Staff and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after. During records review, LPA did not observe a complete resident file for Resident #1 (R1). The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 30, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b)(F) · Plan of correction due date: Jan 10, 2025

87506(b)(F) Each resident’s record shall contain at least the following information...(17) documents and information...(F)Section 87505, Documentation and support. This requirement was not met as evidenced by: Based on records review for R1 resident records reviewed did not have a complete resident appraisal, physicians’ report, preplacement, and a needs and services plan. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 30, 2024

Plan of correction: Licensee agreed to ensure a complete file is maintained for residents upon admission to the facility. Licensee also agreed to submit proof of understanding of reg cited and a written plan to ensure complete files are maintained and submit to LPA via email by EOD 01/10/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne arrived to the facility at 11:32 AM to conduct an unannounced Case Management visit at the facility today. LPA met with facility Administrator Lala Soghonyan. The LPA advised the Administrator of the reason for the visit. During the physical plant tour at 11:36 AM LPA observed the sliding door in the living room of the facility to be missing an auditory alarm. LPA informed the administrator who agreed to install a replacement alarm. At 11:40 AM LPA observed the living room pantry to contain three (3) expired and/or damaged food cans as well as one (1) unsecured box of prescription lancets. LPA informed the administrator who secured the items immediately. At 11:52 AM LPA observed an unsecured shed in the back of the facility. LPA observed the shed to contain tools, cleaning supplies and extra care supplies. LPA informed the administrator who agreed to secure the shed. At 02:40 PM LPA observed the facility’s first aid kit. The kit was observed to be missing Sterile first aid dressings, bandages or roller bandages, scissors, tweezers, and a current version of a first aid manual. The entire property is not fenced and is connected to three (3) adjacent properties. A certificate of occupancy was requested for this property and the adjacent three (3) buildings on the property. During file review at 12:18 PM LPA observed four (4) of five (5) resident files to be missing signatures on documents including but not limited to: admission agreements, consent forms, identification and emergency contact information, appraisal needs and services, and property and valuables. LPA informed the administrator who agreed to get the signatures of the responsible parties of each resident on all identified forms. LPA observed one (1) staff file to be missing the required annual trainings. LPA informed the administrator who agreed to conduct the required trainings with the identified staff member. Continued on LIC 809C. During medication review at 01:21 PM LPA observed two (2) of three (3) residents files to have their medications incorrectly logged on their respective centrally stored medication and destruction record sheets. LPA informed the facility administrator who agreed to conduct a medication audit and to update the centrally stored medication and destruction record sheets for the identified residents. The Administrator was unable to sigh the report at the time it was delivered but has designated facility manager Iveta Darabedyan to sign on their behalf. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 12, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(j) · Plan of correction due date: Nov 26, 2024

87705 Care of Persons with Dementia (j) - The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as one sliding door was observed to be missing an auditory alarm which poses a potential safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator agreed to purchase and install a new auditory alarm. Administrator will submit proof of installation to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(b) · Plan of correction due date: Nov 26, 2024

87506 Resident Records (b) Each resident’s record shall contain at least the following information: This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as four of five resident files were missing required signatures on required documents which poses a potential safety and personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator agreed to get the required signatures from resident's responsible parties on all identified documents. Administrator will submit proof to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Nov 12, 2024

87608 Postural Supports (5) Under no circumstances.... (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a... plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation and record review the licensee did not comply with the section cited above as one resident's bed contained full bed rails and did not have an order which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator agreed to remove the full bed rails from the identified resident's bed. Administrator may submit a physician's order for full bed rails to CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(a)(8) · Plan of correction due date: Nov 26, 2024

87465 Incidental Medical and Dental Care (8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained... shall contain at least the following: This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the facility first aid kit was observed to be missing sterile dressings, roller bandages, scissors, tweezers, and a first aid manual which poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator agreed to purchase a new first aid kit. Administrator will submit proof of new first aid kit purchase to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Nov 26, 2024

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications...is maintained... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as two of three resident's medications were not properly logged on their CSMDR which poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator agreed to complete a medication audit and to log all medications properly on their respective CSMDR. Administrator will submit proof to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87507(c) · Plan of correction due date: Nov 26, 2024

87507 Admission Agreements (c) Admission agreements shall be signed and dated...no later than seven days following admission... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as two of four resident's admission agreements were not signed by their responsible parties which poses a potentialpersonal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator agreed to have all identified admission agreements signed by resident's responsible parties. Administrator will submit proof to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Nov 26, 2024

87555 General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality... Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as three expired / damaged food cans were observed in the pantry which poses a potential health risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator will conduct an audit of all facility food and will dispose of any expired food items. Administrator will submit proof to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(b)(2) · Plan of correction due date: Nov 26, 2024

-1569.625 - (2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually... This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above asone staff member was observed to lack the required annual trainings which poses a potential health, safety, and personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator agreed to conduct trainings with the identified staff member and will submit proof of completion to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f) · Plan of correction due date: Nov 13, 2024

(f) The following shall be stored inaccessible to residents with dementia: (1) ... tools and other items that could constitute a danger to the resident(s). (2) Over-the-counter medication... alcohol, cigarettes, and... cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as LPA observed an unlocked shed in the backyard to contain cleaning supplies and tools which poses an immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator agreed to secure the shed. Administrator will submit proof to CCLD no later than POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Nov 13, 2024

87465 (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as LPA observed an unsecured box of perscription lancets in the pantry closet which poses an immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 12, 2024

Plan of correction: Administrator secured the lancets at the time of the visit POC cleared.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPA) Brian Balisi conducted an unannounced Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint control # 29-AS-20241014112146). The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint. Upon arrival LPA met with Staff Zhyparkul Mursamambetova and explained the reason for the visit. LPA contacted Licensee Sarkis Dovlatyan who stated they are unable to make the visit, but stated staff can sign in their place. During the investigation it was revealed that the facility did not submit a Special Incident Report (SIR) or death report to Community Care Licensing (CCL) to notify that Resident #1 (R1) was admitted to the hospital on 06/18/2024 and R1’s death in the hospital on 06/18/2024, in a timely manner. At approx 9:55 a.m. LPA conducted records review and did not observe any records kept onsite for R1. A $1,000 immediate civil penalty is assessed today. The staff was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed and copy of report provided.the state’s words, verbatim · CDSS document, Oct 18, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A)(B) · Plan of correction due date: Oct 21, 2024

Each licensee shall furnish to the licensing agency such reports... (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as Licensee did not submit an incident report on 04/13/2024 for R1's hospitalization, nor a death report on 05/09/2024 for R1, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2024

Plan of correction: The licensee agreed to submit a plan describing how they will ensure reporting requirements are followed and have administrator complete training in Reporting Requirement training. Submit proof to CCL by COB 10/21/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(b)(F) · Plan of correction due date: Oct 21, 2024

87506(b)(F) Each resident’s record shall contain at least the following information...(17) documents and information...(F)Section 87505, Documentation and support. This requirement was not met as evidenced by: Based on records review for R1 resident records reviewed did not have a complete resident appraisal, physicians’ report, preplacement, and a needs and services plan. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2024

Plan of correction: Licensee agreed to maintain full resident files in the facility. Licensee also agreed to submit proof of understanding of regulation cited and submit to LPA via email by EOD 10/25/2024.

Allegation investigated: Staff did not transport resident to medical appointments. Staff did not administer resident's medication as prescribed.

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the above allegation. Upon arrival LPA met with Staff Zhyparkul Mursamambetova and explained the reason for the visit LPA contacted Licensee Sarkis Dovlatyan who stated they are unable to make the visit, but stated staff can sign in their place. On 04/16/2024, the Woodland Hills North Adult and Senior Care Regional Office (RO) received a complaint regarding neglect/ lack of care. The complaint alleged that the staff neglected to transport Resident #1(R1) to medical appointments (dialysis). The complaint was referred to the Community Care Licensing Division (CCLD) Investigations Branch (IB) and assigned to Investigator Christine Ferris. On 04/17/2024, from 9:30 a.m. to 12:30 p.m., LPA Balisi conducted an initial 10-day complaint visit to investigate the allegation listed above. At approximately 10:00 a.m., the LPA conducted a physical plant tour, interviewed staff, and reviewed and obtained copies of pertinent documentation relevant to the investigation. Substantiated Continued from 9099 On 05/28/2024, from approximately 12:30 pm to 2:45 p.m., Investigator Ferris conducted interviews with residents, caregiver, Resident #2’s (R2’s) resident representative, and Assistant Administrator; on 06/03/2024, at approximately 1:30 p.m., with R1’s resident representative; on 06/10/2024, from approximately 9:45 a.m. to 1:00 p.m., with Catered Manor Nursing Center Administrator, Social Worker, and Case Manager, with Vanalden Villa staff, and R1’s resident representatives: and on 06/17/2024, at approximately 1:00 p.m., with DaVita Warner Center Dialysis Center Administrative Assistant. In addition, the investigator reviewed Valley Presbyterian Hospital medical records, Catered Manor Nursing Center medical reports, and death certificate for R1. There was not a complete resident file for R1 available to review and the licensee was cited on a separate report during the initial complaint visit on 04/17/2024. According to the information provided by the facility caregiver and assistant administrator, R1 was placed at the facility on 04/10/2024 and they were not provided with any documents or information concerning R1. They were aware R1 needed dialysis three times per week, but stated there were issues with the transportation company and R1 did not receive dialysis while in the facility. On 04/13/2024, R1 was taken to the hospital. Interviews with the DaVita Warner Center Dialysis Center revealed the board & care facility did not arrange transportation and Warner Center Dialysis Center was not responsible for arranging the patient’s (R1’s) transportation to dialysis. In addition, information provided by the Catered Manor Nursing Center Social Worker revealed R1’s insurance authorization for transport was completed and the assisted living facility was responsible to make arrangements with the transport company for R1’s dialysis appointments. The review of the Valley Presbyterian Hospital medical records revealed R1 was admitted to the Emergency Room (ER) on 04/13/2024 at 11:22am. The patient notes indicated R1 was brought in by ambulance for fever, weakness, and missed dialysis. R1’s medical history included alcohol abuse, end-stage renal disease on hemodialysis, and hypertension. Continued from 9099-C R1 stated that R1 has hemodialysis three times a week but has not had dialysis for two weeks for unknown reasons. Chest x-ray showed possible pneumonia. Pulmonary/critical care, nephrology consulted for further recommendations and R1 was admitted to the intensive care unit for further care including careful hydration, antibiotic therapy, and infectious source control. R1 was diagnosed with Sepsis, unspecified organism, other toxic encephalopathy, pneumonia, unspecified organism, severe sepsis with septic shock, end stage renal disease, E coli bacteremia, source permacath (permanent catheter for dialysis, unstageable pressure injuries on left and right heel, and stage 2 pressure injury to sacro coccyx. On 05/09/2024, R1 passed away in the hospital. The death certificate listed the primary cause of death as alcoholic cirrhosis of the liver and end stage renal disease. Based on the Department’s investigation, staff did not arrange for the dialysis transportation to ensure R1 got to the dialysis center (R1 was supposed to have dialysis 3 times per week), which led to R1 missing the dialysis treatments for the time R1 resided at the facility 04/10/2024 – 04/13/2024, which then led to the hospitalization on 04/13/2024 at 11:22 a.m. with the diagnosis of end stage renal disease, sepsis, UTI, unstageable pressure injuries and stage 2 pressure injury and admitted to intensive care for further care. Therefore, the allegation “Staff did not transport resident to medical appointments” is deemed Substantiated at this time. It was reported that "Staff did not administer resident's medication as prescribed" as it was alleged that R1 was not administered medications as prescribed while residing at this facility. Interviews conducted and records review revealed R1 resided at this facility from 04/10/2024 to 04/13/2024 when R1 was admitted into the hospital. LPA's interview with Staff and Administrator revealed they did not administer any medication for R1 while they resided here. LPA's records review of R1's hospital records indicated R1 was prescribed the following medications: Norepinephrine 250ml@7.5mis/hr,Ondansetron HCI (Zofran lnj)4mg, Acetaminophen (Tylenol Tab) 650 mg,Sodium Chloride 1,000 ml @ 50 m ls/hr Q20H IV, IV Flush (NS 3 ml) 3 mlPER PROTOCOL IV; Ondansetron HCI (Zofran lnj) 4 mg Q6H PRN IV NAUSEA AND/OR VOMITING;Heparin Sodium (Porcine) (Heparin (5000 Units/1 ml)) 5,000 unit 012 SUBQ ,Adm in Dose 5,000 UNIT; Acetaminophen (Tylenol Tab) 650 mg Q6H PRN PO MILD PAIN; , Morphine Sulfate (morphine) 2 mg 04H PRN IV SEVERE PAIN; Naloxone HCI (Narcan) 0.4 mg Q2M PRN IV RR 8 BREATHS/MIN OR LESS; Vancomycin HCI (Vanco Iv Per Pharmacy) VANCOMYCIN PER PHARMACY PER PROTOCOL XX; Continued from 9099 On 05/28/2024, from approximately 12:30 p.m. to 2:45 p.m., Investigator Ferris conducted interviews with residents, caregiver, Resident #2’s (R2’s) resident representative, and Assistant Administrator; on 06/03/2024, at approximately 1:30 p.m., with R1’s resident representative; on 06/10/2024, from approximately 9:45 a.m. to 1:00 p.m., with Catered Manor Nursing Center Administrator, Social Worker, and Case Manager, with Vanalden Villa staff, and R1’s resident representatives: and on 06/17/2024, at approximately 1:00 p.m., with DaVita Warner Center Dialysis Center Administrative Assistant. In addition, the investigator reviewed Valley Presbyterian Hospital medical records, Catered Manor Nursing Center medical reports, and death certificate for R1. There was not a complete resident file for R1 available to review and the licensee was cited on a separate report during the initial complaint visit on 04/17/2024. According to the information provided by the facility caregiver and assistant administrator, R1 was placed at the facility on 04/10/2024 and they were not provided with any documents or information concerning R1. They were aware R1 needed dialysis three times per week, but stated there were issues with the transportation company and R1 did not receive dialysis while in the facility. On 04/13/2024, R1 was taken to the hospital. The review of the Valley Presbyterian Hospital medical records revealed R1 was admitted to the Emergency Room (ER) on 04/13/2024 at 11:22 a.m. The patient notes indicated R1 was brought in by ambulance for fever, weakness, and missed dialysis. R1’s medical history included alcohol abuse, end-stage renal disease on hemodialysis, and hypertension. R1 stated that R1 has hemodialysis three times a week but has not had dialysis for two weeks for unknown reasons. Chest x-ray showed possible pneumonia. Pulmonary/critical care, nephrology consulted for further recommendations and R1 was admitted to the intensive care unit for further care including careful hydration, antibiotic therapy, and infectious source control. R1 was diagnosed with Sepsis, unspecified organism, other toxic encephalopathy, pneumonia, unspecified organism, severe sepsis with septic shock, end stage renal disease, E coli bacteremia, source permacath (permanent catheter for dialysis, unstageable pressure injuries on left and right heel, and stage 2 pressure injury to sacro coccyx. On 05/09/2024, R1 passed away in the hospital. The death certificate listed the primary cause of death as alcoholic cirrhosis of the liver and end stage renal disease. Continued from 9099-C The Department’s investigation did not provide sufficient evidence to substantiate neglect/lack of care. R1 was discharged on 04/05/2024 from Catered Manor Nursing Center to Vanalden Villa with Stage 4 pressure ulcers of the right and left heels, and a sacro coccyx deep tissue injury. Per the Valley Presbyterian Hospital medical records, on 04/13/2024, R1 was diagnosed with sepsis with an unclear source and E coli bacteremia, source permacath (permanent catheter for dialysis), and septic shock, suspect secondary to E coli bacteremia with the source unclear, unstageable pressure injuries to right and left heel, and stage 2 pressure injury to sacro coccyx. Per the Age Well Assisted Living Facility Assistant Administrator and caregiver, R1 resided at Age Well Assisted Living facility from 04/10/2024 to 04/13/2024 when R1 was sent to the hospital. Per R1’s resident representative, R1 resided at Age Well Assisted Living Facility for about “three days” but they never visited R1. Based on the statements and documentation provided, the Department found insufficient evidence to determine if there was neglect or lack of care on behalf of the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation of “Neglect/Lack of Care: Staff neglected or failed to provide an adequate level of care resulting in resident sustaining pressure injuries, septic shock, and an E coli infection” is deemed to be Unsubstantiated at this time. Exit interview conducted and copy of report issued. Continued from 9099-C Cefepime HCI 2 gm/ Sodium Chloride 50 ml@ 100 mis/hr Q24H IVPB , Heparin Sodium (Porcine) (Heparin (1000 Units/ml)) 4,000 unit AFTER DIALYSIS CATHETER ; Albumin Human 100 ml@ 100 mis/hr ONCE PRN IV SBP LESS THAN 90 DURING HD; ,Sodium Chloride 1,000 ml@ 2,000 mis/hr Q30M PRN IV SBP LESS THAN 90 DURING HD; Sodium Chloride 250 ml@ 0 mis/hr QOM IV ; Sodium Chloride 250 ml@ 0 mis/hr QOM IV ; Alteplase, Recombinant (Cathflo (Activase)) 2 mg MAY REPEAT x1 PRN Norepinephrine 250 ml@ 1.875 mis/ hr ONCE STAT IV Albumin Human 100 ml@ 100 mis/hr Q8H IV. Start date for each medication was 04/13/2024. Based on information obtained during the investigation, the department has sufficient evidence to determine that Staff did not administer resident's medication as prescribed while residing at the facility.Therefore, the above allegation “Staff did not administer resident's medication as prescribed" is deemed SUBSTANTIATED at this time. A $500 immediate civil penalty is assessed today. The staff was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) and 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC9099-D). Exit interview conducted, appeal rights discussed, and a copy of this report issuedthe state’s words, verbatim · CDSS document, Sep 27, 2024 · control 29-AS-20240416124733

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(2) · Plan of correction due date: Sep 30, 2024

A plan for incidental medical and dental care shall be developed...In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidenced by Based on interviews and records review, the licensee did not comply with the section cited above. Staff did not arrange for transportation to ensure R1 got to the dialysis treatment center, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: Licensee agreed to submit a plan on how they will ensure residents receive transportation to medical/dental appointments. Submit to CCL via email by COB 09/30/2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 30, 2024

The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by Based on interviews and records review, the licensee did not comply with the section cited above, as staff did not provide R1 medication to R1 while they resided at the facilty, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: Licensee agreed to review section cited and submit a statement of understanding and how they plan to ensure residents will receive their medications as prescribed and submit to CCL via email by COB 09/30/2024

Type of visit: Case Management - Incident

Licensing Program Analysts (LPA) Brian Balisi conducted an unannounced Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint control # 29-AS-20240416124733). The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint. Upon arrival LPA met with Staff Zhyparkul Mursamambetova and explained the reason for the visit. LPA contacted Licensee Sarkis Dovlatyan who stated they are unable to make the visit, but stated staff can sign in their place. The facility did not submit a Special Incident Report (SIR) or death report to Community Care Licensing (CCL) to notify that Resident #1 (R1) was admitted to the hospital on 04/13/2024, and R1’s death in the hospital on 05/09/2024. Facility admitted and retained R1 with unstageable pressure injuries to both heels and a Stage 2 pressure injury to sacro coccyx without submitting and exception request for the prohibited condition (unstageable pressure injuries) and obtaining approval from CCL. Staff #1 (S1) stated they are the only staff at the facility and has worked as a caregiver at the facility since 03/15/2023. S1 stated they work “six days a week, 24 hours a day.” S1’s duties as a caregiver include cooking, cleaning, laundry, showering, changing diapers, and changing clothes. Resident #2 (R2) stated S1 works “24/7”. Records review lists Lala Soghomonyan as Administrator, but there were no records to review on site. LPA contacted Lala who stated they were unable to make it to the facility. Citations issued, exit interview, appeal rights given.the state’s words, verbatim · CDSS document, Sep 27, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615((a)(1) · Plan of correction due date: Sep 30, 2024

(a) Persons who require health services for or have a health condition... admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries.This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: The licensee agreed to review regulation cited and submit a memo of understanding that licensee will not admit or retain residents with prohibited health conditions without first submitting an exception request and receiving approval from CCL. Submit proof to CCL by COB 09/30/2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR87411(a) · Plan of correction due date: Sep 30, 2024

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by Based on interviews, the licensee did not comply with the section cited above. There was only one caregiver working at the facility, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: The licensee agreed to submit a current and complete LIC500 Personnel Report reflecting adequate staff coverage 24/7 and include the administrator’s days and hours present at the facility. Submit proof to CCL by COB 09/30/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A)(B) · Plan of correction due date: Oct 4, 2024

Each licensee shall furnish to the licensing agency such reports... (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above as Licensee did not submit an incident report on 04/13/2024 for R1's hospitalization, nor a death report on 05/09/2024 for R1, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: The licensee agreed to submit a plan describing how they will ensure reporting requirements are followed and have administrator complete training in Reporting Requirement training. Submit proof to CCL by COB 10/04/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(d) · Plan of correction due date: Oct 4, 2024

(d) The licensee shall maintain documentation that an administrator... has met the certification requirements specified in Section87406....Administrator Recertification Requirements. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as the Administrator file is missing the following documents: LIC 501, LIC 503, TB Test, LIC 9052, SOC 341a, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 27, 2024

Plan of correction: LIcensee agreed to submit the required documents to CCL via email by COB 10/04/2024.

Allegation investigated: Facility staff did not follow reporting requirements.

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met wit Staff Zhyparkul Mursamambetova and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after. On 7/18/2023, the initial complaint visit was conducted by LPA Balisi between approximately 10:30 a.m. - 4:15 p.m. During the visit, LPA conducted physical plant, interviewed staff, residents, responsible parties, as well as, reviewed and obtained copies of pertinent documentation relevant to the investigation. On 11/21/2023, LPA reviewed North Los Angeles Regional Center Records for Resident #1 (R1). On 07/23/2024. LPA interviewed Juliet Allahverdi North Los Angeles Regional Center Service Coordinator (NLARC) Continued on 9099-C Substantiated Continued from 9099 It was reported that staff did not communicate promptly and appropriately with resident’s family / representative, as it was alleged that Resident #1 (R1) was admitted into the hospital , but facility staff did not inform R1. Interviews conducted and records review revealed that R1 resided at this facility from 05/16/2023 to 05/28/2023, when R1 was admitted into a local hospital. On 06/08/2023, R1’s family / representative requested to speak to R1 , but was told by Staff #1 (S1) that R1 was no longer at the facility and they were admitted into a local hospital. During the time of the investigation, S1 and staff at the facility did not have any knowledge of R1’s whereabouts after they were transported to the hospital. On 07/17/2023, (NLARC) located R1 at a Skilled Nursing Facility (SNF) in Downey, CA. On 07/18/2023, R1’s family / representative was notified of R1’s location. Based on information obtained during the investigation, the department has sufficient evidence to determine that R1’s family / representative was not contacted after being admitted into the hospital. Therefore, the above allegation “Staff did not communicate promptly and appropriately with resident’s family is deemed SUBSTANTIATED at this time. The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 30, 2024 · control 29-AS-20230714110246

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 9, 2024

87211(a)(1) Reporting Requirements - (1) A written report shall be submitted to the licensing agency and to the person responsible... if any; and disposition of the case. This requirement was not met as evidenced by: Based on information gathered during the investigation the licensee did not comply with the section cited as R1’s Family / representative were not notified promptly when they were admitted into the hospital. This poses as a potential health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Jul 30, 2024

Plan of correction: Licensee agreed to submit a statement of understanding demonstrating full understanding of the regulation cited and sent to LPA via email by COB 08/09/2024.

Allegation investigated: Staff did not meet resident's medical needs.

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the above allegation. During today’s visit, LPA met wit Staff Zhyparkul Mursamambetova and explained the reason for the visit. Licensee Sarkis Dovlatyan arrived shortly after. On 9/18/2023, the initial complaint visit was conducted by LPA Balisi between approximately 01:30 p.m. - 4:30 p.m. During the visit, LPA conducted physical plant, interviewed staff, residents, as well as reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that “Staff did not meet resident's medical needs”, as it was alleged that Resident #1 (R1) requested to see a doctor due to feeling ill. Interviews and records review reflected that on 09/09/2023, R1 requested assistance from Staff #1(S1) due to feeling lightheaded. Continued on 9099-C Unsubstantiated Continued from 9099 S1 informed R1’s Administrator who advised S1 to provide extra fluids and have R1 rest in bed. Additionally R1 stated they have not requested any assistance from S1 or other staff to contact their primary care physician. Furthermore R1 did not express any immediate or potential concerns for not being able to contact their primary care physician at this time. Interviews conducted with four (4) other residents in care revealed that all (4) residents did not express any immediate or potential concerns with staff assisting them with contacting their primary care provider. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff did not meet resident's medical needs”, is deemed Unsubstantiated at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Jul 30, 2024 · control 29-AS-20230915101714

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility. Upon arrival LPA met with head caregiver Zhyparkul Mursamambetova and explained the reason for the visit. Assistant Administrator Elena Kordonsky arrived shortly after. At approx 9:30am, LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The following was noted: A tour of the physical plant was conducted. The facility has three (3) bedrooms and two (2) bathrooms currently occupying four (4) residents. One (1) bathroom is designated for staff use only, but is available for residents if needed. All smoke alarms and carbon monoxide detector were tested and functioned properly during time of visit. LPA observed required postings in the living area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Sharp objects are stored in a locked drawer to the right of the dishwasher. Medication is stored in a locked cabinet above the dishwasher. The resident bedrooms were properly furnished with at least one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed all bathrooms were clean, properly supplied and had functional fixtures. LPA observed grab bars and non-skid mats in the bathroom Residents have sufficient amounts of supplies for personal hygiene stored in the designated staff bathroom. The hot water was measured in each bathroom during physical plant tour. Hot water measured within the required limit of 105-120 degrees Fahrenheit in all bathrooms during visit. Laundry area was located in the staff bathroom as well. Cleaning supplies were observed stored in locked cabinets located in staff bathroom inaccessible to residents in care at this time. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. There was an Adult Dwelling unit located in the rear of the facility. LPA observed unit to be empty at this time and inaccessible to residents care. LPA observed storage unit to the left of the home. Storage unit was observed to store extra furniture, hardware and other items for facility use. The property is gated with a motorized gate leading into driveway. There is an entry way gate for client use and is single latched. No bodies of water noted at this time. Records review began at 09:55 am, five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At approx 10:30am, Records review revealed the following: Resident #3(R3) did not have LIC 602 (Physicians Report) in file for review. Resident #4 (R4) and Resident #5 (R5) did not have complete Needs and Appraisal forms in file. On 4/10/2024, R5 was admitted into the facility and physician's report dated 04/09/2024, lists R1 as having no capacity for self-care which is a prohibited health condition. The licensee did not submit an exception request to admit and retain the resident with a prohibited health condition. LPA reviewed staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification. Continued from 809-C At approx 11am, LPA observed a new Administrator Certificate for Yelizaveta Gasparyan posted on a wall. The Licensee did not submit any documentation or notify LPA of a new Administrator. LPA did not observe Administrator files on site for review. Medications review began at 01:30pm The medications are centrally stored in a locked cabinet above the microwave. LPA reviewed medications for the (5) residents in care. Medications are labeled and checked for expiration dates. Medications were observed to be properly documented on the centrally stored medications and destruction record at this time. During today’s visit, the LPAs obtained copies of the following: staff roster, staff schedule, and resident roster. LPA conducted interviews during the time of the visit. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed and copy of report provided.the state’s words, verbatim · CDSS document, Jul 9, 2024

Allegation investigated: Staff speak inappropriately to resident

Licensing Program Analyst (LPA) Zabel Chochian conducted a complaint visit to this facility regarding above allegation. Upon arrival LPA met with staff and reason for the visit was explained. Staff contacted Administrator Sarkis Dovlatyan and Administrator assistant Elena Kordonskiy. Mr. Dovlatyan stated that he is in a meeting and wont be available today. LPA spoke with Ms. Kordonskiy who stated that she is out of town and will be back tomorrow. Following is a summary of the allegation and investigation conducted: On May 1, 2024, the Department received a complaint alleging that staff speak inappropriately to resident. Concerns reported were that "a nurse" at the facility calls resident (R1) "profanity names" and "spits" in resident's face when they talk. It is unknown if the nurse intentionally spits in resident's face. According to the reporting party there is no additional information available regarding the allegation. (Continue to LIC9099c). Unsubstantiated During todays visit LPA obtained copy of the facility resident roster and the personnel report. Between 12:30pm-2pm LPA conducted interviews with staff, five (5) residents and a potential witness. Additional potential witnesses were interviewed at approximately 2:30pm and 3:30pm. Staff and potential witnesses interviewed denied the allegation. During resident interviews, four (4) out of five (5) residents were able to comprehend questions asked and expressed that they are not mistreated by any staff or "nurse". Residents interviewed expressed that visiting nurses and staff are helpful and nice. Residents interviewed stated that they are not mistreated and have not observed any mistreatment in the facility by any staff or nurses. Potential witnesses interviewed stated that they have not observed any resident be mistreated by staff or any visiting nurse. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff speak inappropriately to resident” is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, May 7, 2024 · control 29-AS-20240501152412

Type of visit: Case Management - Deficiencies

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Type of visit: Case Management - Deficiencies

Read the state’s words on page 2 of the record →

Type of visit: Case Management - Other

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