All Star Living

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Erica Mosley and Sandra Urena arrived unannounced at the facility to conduct the required annual inspection. The LPAs were greeted by staff and informed them of the reason for the visit. The newly hired Administrator Arshalouis Manoukian was hired on 04/24/2026, arrived shortly thereafter. The LPAs and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. The common areas, walls, flooring and furniture were checked for cleanliness and were found to be in good condition. Some of the required postings were observed on a board on the wall next to the kitchen area. Fire extinguisher was expired on 02/12/2026. The Administrator purchased one and replaced the expired extinguisher during the visit. KITCHEN: Kitchen knives are stored locked, and inaccessible to residents in a kitchen cabinet. The supply of perishable food is adequate, however the non-perishable 7-day supply is not sufficient at the time of the visit, as only 10 cans of food and several bags of pasta were observed in the pantry. The supply of dishes is adequate. Appliances in the kitchen were clean, and all appeared to be functional. LAUNDRY: Washer and dryer are located in the kitchen area. BEDROOMS: The facility has (4) bedrooms, all bedrooms are resident bedrooms. No staff bedroom was available. Bedrooms #1 and #4 are single occupancy, bedrooms #2 and bedroom #3 are shared rooms. Room #1 was furnished and set up according to regulations. However, rooms # 2, 3, and 4, were observed to have the furniture moved to the center of the room. Per the Administrator, the rooms will be painted and re-organized with new furniture, and the work will be completed by 04/30/2026. BATHROOMS: There are two (2) full bathrooms. One is a private bathroom in bedroom #1, and the second bathroom is located in the hallway. The shower is equipped with nonskid mats. Grab bars were observed in the bathrooms. The hot water temperature in the bathroom measured 117.1 degrees Fahrenheit. The hallway bathroom lacks a window screen that needs to be replaced. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is one side gates for client use and are single-latched. RECORDS: Records review began at 2:20 p.m. Residents’ records were not available for review for one resident. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training. Personnel files reviewed revealed that staff do not meet the initial 40 hours of required training. File review revealed that staff completed between eight (8) to nine (9) hours of training. MEDICATIONS: Medications are stored in kitchen cabinet that was observed to be locked; however, no medications were observed in the cabinet at the time of the visit. Only one resident is currently residing at the facility, and the resident is keeping the medications in their room as the resident can manage their own medications. The medications were not documented properly on the centrally stored medications and destruction record. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability of Insurance Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 809-D). Citations and civil penalties were issued. Exit interview was conducted. A copy of the report and Appeal right were issued.the state’s words, verbatim · CDSS document, Apr 27, 2026

Allegation investigated: Facility staff did not treat resident(s) with dignity and respect.

Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to deliver the findings for the allegation listed above. The LPA met with the designated staff Yasir Amir, and explained the reason for the visit. On 03/27/2026, the Community Care Licensing Department received a complaint about violation of personal rights. On 04/01/2026, LPA Urena conducted an initial visit to investigate the allegation listed above. The LPA interviewed the designated staff for the facility Yasir Amir and requested records pertinent to the investigation. Furthermore, on 04/01/2026, LPA Urena interviewed the reporting party (RP) and the resident’s acquaintances. Continues on LIC9099C... Unsubstantiated Facility staff did not treat resident with dignity and respect. On the allegation that Facility staff did not treat the resident with dignity and respect, it is the concern of the RP that R1 is being yelled at by facility staff, consequently violating the R1’s personal rights. To investigate the allegation, LPA Urena conducted records review, and interviews. Per the records review, R1 left the facility in mid-March. The facility’s designated staff Yasir Amir reported that R1 left the facility to live with friends. Per the RP’s interview, the R1 reported that they were at another facility, but did not know the name of the facility, only the address. The address provided by the R1 did not match the address of the All Star Living Inc. facility at the time of the complaint. The LPA was unable to interview the R1. Although the allegation may have happened or is valid, based on the interviews, observation, and record review, there is not sufficient evidence to prove that the alleged violation did or did not occur at the All Star Living Inc. facility, therefore the allegation is Unsubstantiated at this time. No citations were issued. Exit interview was conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 7, 2026 · control 29-AS-20260327154505

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sandra Urena conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20260327154505). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation unrelated to the complaint. During today’s visit, LPA met with Yasir Amir and the reason for the visit was explained. During the course of the investigation, it was observed that the facility’s front door had a padlock on the inside of the facility with a small combination lock hanging from one end of the padlock. Although the lock was unlocked at the time of the visit, based on residents’ interviews, it was determined that the padlock is locked at other times of the day, preventing residents from exiting the facility through the main front door. Based on observation, the Administrator was determined to lack the knowledge to prevent deficiencies which poses an immediate health and safety risk to persons in care. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Exit interview conducted, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 7, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Apr 10, 2026

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observation, LPA observed a padlock with a combination lock installed on the main entrance front door of the facility, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 7, 2026

Plan of correction: In accordance with the California Health and Safety Code Section 1568.0822(c), you are hereby notified that an immediate $500 civil penalty per violation is assessed today. This is zero tolerance violation. The padlock and combination lock were removed immediately during today’s visit. The Licensee/Administrator agreed to review the Health and Safety Code and regulations pertaining to Fire Safety and submit self-certification to the LPA by 04/10/2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(d)(2) · Plan of correction due date: Apr 24, 2026

87405 (d) (2) Administrator-Qualifications and Duties. The administrator shall have the knowledge of and ability to conform to applicable laws, rules and regulations. If the licensee is also the administrator, all requirements for an administrator shall apply…This requirement is not met as evidenced by: Based on observation, the facility had a padlock preventing residents from exiting the facility through the front main entrance/exit in case of an emergency, Health and Safety Codes violations were observed during today’s visit, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 7, 2026

Plan of correction: POC: Licensee agreed to attend outsourced training by an approved vendor regarding administrator qualifications and health and safety. Proof of training sign-up shall be submitted by 04/10/2026, and proof of the completed additional 40 hours shall be submitted by 04/24/2026 to LPA. Submit vendor name, address, vendor number and phone number with date of training. Follow up with a training certificate and a detailed agenda.

Type of visit: Office

An Informal Conference was conducted today in the Woodland Hills Adult and Senior Care Regional Office. The purpose of this Informal Conference is to discuss deficiencies cited during the period of 2025 and 2026 as well as concerns arising from case management deficiencies. Present at today's meeting included the Licensee (All Star Living Inc.) Satenik Alajanyan, Yasir Amir, and Estelita Agpada, Licensing Program Manager (LPM) KaSandra Lopez and Licensing Program Analyst (LPA) Sandra Urena. The informal conference process was explained to the Licensee. The Licensee was informed that this Informal Conference is a part of the administrative action process and that further citations may result in a Non-Compliance Conference, which could lead to a referral for Administrative Review by the Department’s Legal Division for possible Administrative Action. Citations discussed related to: Operating overcapacity and having 7 residents when only fire department cleared for 6 residents of which civil penalty was issued, a resident eloping which resulted in found wandering in the streets and picked up by LAFD, staff not having current CPR and medication training, residents not having pre-admission appraisals, two citations related to reporting requirements, staff administering unprescribed medications to resident, medication review that resulted in inconsistency on how medications are prescribed and the amount of medication remaining, cockroaches observed in kitchen and pantry, and facility telephone number not being available for family use. Continues on LIC 809C... Today, a Case Management report was also issued for deficiencies observed by the LPA on 01/27/2026. Those additional deficiencies include 87457 Pre-Admission Appraisal, 87608 (5)(B)-Postural Supports, 87303 (a)Maintenance and Operation 87555(b)(27), HSC 1569.69(b) Medication training, 87355(e)(1) Criminal Record Clearance. Outstanding plan of corrections were also discussed, and the licensee has until Tuesday, February 17, 2026, to submit POCs for the 10/15/2025 Complaint and Case Management visits, and the 2/3/2026 Complaints visits. The CCLD’s Technical Support Program (TSP) was explained to the Licensee. The Licensee was also provided the CCLD website information and was also provided paper copies of resource guides for Hospice Care, Medication Guide, and the Pressure Injuries Guide which can also be found on the CCLD’s website along with other resources, including a RCFE assessment guide so you can be prepared for your first annual inspection. The licensee explained that their plan of action to be in compliance with the department includes hiring a designated Administrator and consistent staff (caregivers). The Licensee agreed to be referred to TSP. Brief History: The facility was first licensed on 04/01/2025, for a capacity of six (6) residents. The parties discussed deficiencies related to the following incidents and observations: 06/19/2025-Case Management Deficiency · During interview with Staff #1 (S1) revealed that sometime early in June 2025 the exact date is unknown the facility was over capacity and had seven (7) residents. Cited for 87204 Limitations - Capacity and Ambulatory Continues on LIC 809C... 08/21/2025-Complaint #29-AS-20250821122539 · Lack of supervision resulting in resident eloping from the facility. · Cited for 87464(f)(1) Basic Services. 08/25/2025-Case Management Deficiency · Staff did not have CPR/First Aid Training. · Cited for 87411(c)(1)(2) (c) Lack of training. 10/11/2025-Complaint C#29-AS-20251011205324 · Staff provided unprescribed medication to resident. · Cited for 87465 (a)(2)- Incidental Medical and Dental Care 10/15/2025-Case Management-Defiency · Licensee did not report to CCL about staff providing unprescribed medication to resident. · Cited for 87211 Reporting Requirements (a) (1)(A-D) 01/27/2026- Complaint #29-AS-20260127125601 Allegations: · Staff did not administer medication to a resident in care. · Staff did not keep facility free of vermin. · Cited for 87465(a)(4) and General Food Service Requirements (b)(27) 02/04/2026-Complaint #29-AS-20260204082332 · Facility staff are not answering communications from resident’s representative. · Cited for 87468.1(a)(9)(14)-Personal Rights 02/12/2026-Case Management-Deficiency · 87457 Pre-Admission Appraisal · 87608 (5)(B)-Postural Supports · 87303 (a)Maintenance and Operation · 87555(b)(27) · HSC 1569.69(b) Medication training · 87355(e)(1) Criminal Record Clearance Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 12, 2026

Type of visit: Office

On February 12, 2026, Licensing Program Analyst Sandra Urena and Licensing Program Manager KaSandra Lopez met with Satenik Alajanyan for an Office Meeting. During this meeting, a Case Management Deficiencies report was issued in conjunction with a complaint visit (Complaint Control # 29-AS-20260127125601). The purpose of this report is to issue citations for deficiencies observed during the initial complaint investigation unrelated to the complaint. During today’s meeting the LPA explained the reason for the report. During the course of the investigation, it was discovered that a resident who was admitted to the facility on 01/21/2026, following discharge from a medical center, was admitted without the proper documentation (pre-appraisal) to assess the needs of the resident prior to admission. Furthermore, the administrator did not conduct formal admission process and did not complete the required Community Care Licensing forms to create a resident’s file and did not meet nor communicate with the resident’s responsible party, which poses / posed an immediate health, safety or personal rights risk to persons in care. During the walk through of the facility at approximately 11:05 a.m., the LPA observed that a resident in bedroom # 2 was in bed with full bed rails. The bed rails were raised at the time of the visit. When the LPA asked the administrator to provide the doctor’s orders for the full bed rails, the administrator was unable to provide the documentation and/or doctor’s order for the full bed rails. Continues on LIC 809C...page 2. Page 2. At approximately 11:35 a.m. the LPA observed the following physical plant areas in disrepair. Bedroom #3 closet has a hole inside the closet near the ceiling, which appeared to be in size about 12” X 12” inches wide. The bedroom window was stuck and could not be open for fresh air. The window blind is missing two vertical slats, allowing for the light to shine through. At the time of the observation the resident had a piece of clothing hanging by the top of the blind to keep the light from shining in. Per the resident, the next-door neighbor’s outdoor light shines through at night, and it disturbs the resident’s sleep. Bedroom #2 also has vertical blinds slats missing. The window facing the street is missing the window screen, consequently the residents don’t open the window to not let mosquitoes in. The LPA noticed that fire extinguisher which is located by the doorway of the kitchen and the common area, did not have a receipt with the date of purchase. When the LPA asked the administrator for the receipt, the administrator could not provide one. During the physical plant inspection of the facility’s kitchen, at approximately 12:19 p.m., the LPA observed bananas in the pantry area; the bananas were extremely spoiled. The LPA observed the brown bananas to be inside a plastic bag, with liquid spilling from the plastic bag, when the LPA moved the bags, several small cockroaches scurry away. Furthermore, upon inspection of the refrigerator, the LPA observed a bag which had old, spoiled bread, and boxes of cookie dough with the expiration date of 11/10/2025. Inside the refrigerator, the LPA observed several boxes and bags of insulin pens in the refrigerator that belonged to two (2) residents of the facility. The insulin pens were in between other food items, and accessible to residents in care. During the inspection of the insulin pens, the LPA interviewed the staff (S1) present and asked who administered the insulin to the residents, the staff replied that they did. When the LPA asked if the staff were qualified staff (LVN, RN) to administer the insulin injections, the staff replied, “No, but the administrator said we could”. Continues on LIC 809C... page 3. Page 3. Two (2) people who identified themselves as facility staff were on the premises caring for the residents during the course of the investigation. Upon inspection of the staff files, it was observed by the LPA that the two people caring for the residents did not have background clearance, were not associated with the facility per the department’s personnel summary report and had not received the required training by the CCL department. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Citations were issued. Exit interview conducted, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 12, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87456(b) · Plan of correction due date: Feb 17, 2026

87457 Pre-Admission Appraisal (b) No person shall be admitted without his/her consent and agreement, or that of his/her responsible person, if any. This requirement is not met as evidenced by: Based on interviews, and file review the licensee did not comply with the section cited above as the facility admitted Resident #1 (R1) without proper documentation which poses / posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: The licensee will submit a self cetification that they have reviewed the regulation and will follow it. Licensee has until Tuesday, February 17, 2026, to submit POCs

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608(5)(B) · Plan of correction due date: Feb 17, 2026

87608 (5)(B)-Postural Supports (5) Under no circumstances shall postural supports include...(B)Bed rails that extend the entire length of the bed are prohibited except for ... care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation the licensee did not comply with this requirement as one resident was observed with full bed rails without a doctor’s order, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: The licensee will submit a self cetification that they have reviewed the regulation and will follow it. Licensee has until Tuesday, February 17, 2026, to submit POCs

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 27, 2026

87303 (a)Maintenance and Operation- (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents... This requirement is not met as evidenced by: Based on observation the licensee did not comply with this requirement as the facility was observed in disrepair in several areas, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: The licensee will submit a self cetification that they have reviewed the regulation and will follow it. Pictures of the reapirs Licensee has until Tuesday, February 17, 2026, to submit POCs

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(27) · Plan of correction due date: Feb 20, 2026

87555(b)(27) General Food Service Requirement (b)The following food service requirements shall apply (27) 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 observation the licensee did not comply as spoiled food and vermin were observed in the pantry area, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: The licensee will submit a self cetification that they have reviewed the regulation and will follow it. Licensee has until Tuesday, February 17, 2026, to submit POCs

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.69(b) · Plan of correction due date: Feb 19, 2026

HSC 1569.69(b) Medication training- Employees assisting residents with self-administration of medication; training requirements (b) Each employee who received training...self-administration of medicines, shall also complete eight hours of ...medication-related issues in... This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with this section as staff (S1) injected insulin to residents in care, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: The licensee will provide training to staff on medication. Training will be provided by a certified professional. Licensee will contact the residents' physician to get proof that residents can inject the insulin themselves, and if not Licensee will submit a plan how they will insure ASP will provide the insulin injections.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(1) · Plan of correction due date: Feb 17, 2026

87355(e)(1) Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to...(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 and S2, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: The licensee will submit a self cetification that they have reviewed the regulation and will follow it. Licensee has until Tuesday, February 17, 2026, to submit POCs

Allegation investigated: Facility staff are not answering communications from resident’s representative.

Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced 10- day visit to investigate the allegation listed above. The LPA met with the Administrator Satenick Alajanyan and explained the reason for the visit. LPA Urena, along with the administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The LPA looked for the phone (land line or cell phone), and the LPA observed a telephone (landline) located in the living room area by the television area. Continues on LIC 9099C... Substantiated Facility staff are not answering communications from resident’s representative. On the allegation that the facility staff are not answering communications from residents’ representatives, it is the concern of the reporting party (RP) that they have attempted several times to communicate with the residents at the facility since the residents moved in and have not been able to communicate with any facility staff. Furthermore, the RP stated that no one from the facility has returned countless “call back” requests left via voicemail at the facility number (818) 802-0866. On 02/05/2026, LPA Urena called the telephone number on record for the facility which is (818) 802-0866, at approximately 11:09 a.m., and the call was answered by the Administrator Satenik Alajanyan. When the LPA asked whose number was this, the licensee stated that it was the cell number they carried with them. The LPA asked the Administrator to provide the facility’s telephone number, so that LPA Urena could update it in the department’s electronic data system, however, the Administrator stated that they did not know the number and would call the LPA back with the facility’s telephone number. During today’s physical plant tour, LPA Urena observed a land line. Per the Administrator, they forgot to update the telephone number during the application process; furthermore, the Administrator stated that they have not received calls or messages to call anyone back. The Administrator provided the LPA with the correct telephone number (818) 293-4980. The LPA tested the telephone line and found it to be active at the time of the visit. Based on information obtained through the interview and observation, the allegation that facility staff are not answering the phone, is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D). Citations were issued. Exit interview conducted and a copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Feb 9, 2026 · control 29-AS-20260204082332

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(9)(14) · Plan of correction due date: Feb 9, 2026

Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (9)To have communications to the licensee from their representatives answered promptly and appropriately. (14)To have reasonable access to telephones, to both make and receive confidential calls. This requirement is not met as evidenced by: Based on information and observation the Administrator did not comply with the regulation as the cell number recorded on the facility profile is not the telephon number associated to the faciltiy, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 9, 2026

Plan of correction: POC: deficiency has been corrected as of today, as the land line was working propertly during the visit and the LPA was able to confim it via a telephone call. The number for the facility is (818) 293-4980.

Allegation investigated: Staff did not administer medication to a resident in care. Staff did not keep facility free of vermin.

Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegations listed above. The LPA was greeted by staff, and the staff called the Administrator and informed them of the visit. The Administrator did not speak with the LPA. The LPA waited for the Administrator to arrive; however the Administrator did not arrive 30 minutes after the call. The staff attempted to communicate with the Administrator once again, but the call was not answered according to the staff. The LPA called the number on file for the Administrator however the call went to voicemail. At 1:03 p.m. LPA Urena called the Licensee Satenik Alajanyan, and the Licensee stated that they would arrive at the facility within an hour of the call. The LPA explained the reason for the visit and stated they would wait for the Licensee to arrive. LPA Urena, along with the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. Continues on LIC 9099C...page 2. Substantiated LPA Urena interviewed staff and residents from approximately 10:30 a.m. to 12:26 p.m. and requested records pertinent to the investigation. At 2:35 p.m. the Licensee arrived at the facility, and the LPA interviewed the Licensee at approximately 2:40 p.m. Staff did not administer medication to a resident in care.On the allegation that staff did not administer medication to a resident in care, it is the concern of the reporting party that the resident (R1) is not receiving their medication as prescribed. The LPA was unable to communicate with the RP for further information. To investigate the allegation at approximately 1:22 p.m. the LPA conducted a medication audit and interviewed residents. One resident stated they get their medication on time, one resident stated that they do not take medications. The medication audit consisted of reviewing the LIC 622 (Centrally Stored Medication and Destruction Record) and auditing prescription bottles/counting pills. The record review of the LIC 622 for R1 revealed that medications are not being recorded as they are received by the facility and discrepancies were found on dates (filled/ start date/ expiration date) between the LIC 622 and the medication bottles. One medication bottle for Atorvastatin (40mg./100 pills, 1Xd) with a count of 21 pills left in the bottle, showed that the medication bottle was filled on 08/21/2025 per the prescription label, however the LIC 622 stated the medication was filled on 03/27/2025. At the time of the medication audit the medication should have been refilled. It is unknown when the first day of the medication was given as the dates on the LIC 622 could not be confirmed. The second medication audited was Hydralazine (25m./90 pills/3xd) which was not registered in LIC 622. The interview with staff revealed that they assist two residents with insulin injections, furthermore, staff stated that they do give the medications to the other residents as prescribed. However, due to the medications not being properly documented in the LIC 622, it’s impossible to assess if residents have been properly assisted with their prescribed medications. The Licensee’s interview revealed that they could not explain the medication discrepancies. Based on observation of the medication audit, and the interviews, the Staff did not administer medication to a resident in care as prescribed. Therefore, the allegation is deemed Substantiated at this time. Continues on LIC 9099C... page 3. Staff did not keep facility free of vermin. On the allegation that the facility is not kept free of vermin, it is the concern of the RP that the facility has cockroaches and mice. To investigate the allegation, the LPA conducted interviews and inspected the facility grounds. Based on the interview of residents, residents stated that they have seen mice and cockroaches in the kitchen area, but not in their rooms or other areas of the facility. At approximately 12:05 p.m. the LPA inspected the kitchen area and observed cockroaches in the pantry area, while inspecting the dry food items and fruits. The LPA did not observe mice at this time. Based on interviews and observation, the facility is not free of vermin. Therefore, the allegation is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D). Exit interview was conducted. A copy of the report and Appeal Rights were provided. LPA Urena interviewed staff and residents from approximately 10:30 a.m. to 12:26 p.m. and requested records pertinent to the investigation. At 2:35 p.m. the Licensee arrived at the facility, and the LPA interviewed the Licensee at approximately 2:40 p.m. Staff did not ensure that the residents room is free of clutter and trash. Onn the allegation that staff did not ensure that the residents’ room is free of clutter, trash and kept clean, it is the concern of the RP that the residents rooms and bathroom trash cans are overflowing with trash, and the rooms are full of dust. To investigate the allegation, at approximately 10:35 a.m., the LPA conducted a tour of the facility, and observed the residents’ rooms to be clean, and trashcans empty. However, two bedrooms appeared to have lots of personal items that appear to give the room an appearance of clutter. No dust was observed, and residents stated that staff do clean the rooms frequently, at least one a day. Although the allegation may have happened or is valid, based on the interviews, and observation, there is not sufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Exit interview was conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 29-AS-20260127125601

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Feb 9, 2026

87465(a)(4) The licensee shall assist residents with self-administered medications as needed. 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 1 of 4 resident medications reviewed contained inconsistencies with their medication amounts remaining and amounts documented as administered on the centrally stored which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee will provide proof of medication administration training via a professional and will submit proof to LPA via email by the POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(27) · Plan of correction due date: Feb 9, 2026

General Food Service Requirements (b) The following food service requirements shall apply: (27) 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 above in that cockroaches were observed in the kitchen, pantry area.This posed an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Licensee agreed to have a professional exterminator company conduct a fumigation treatment, and email the LPA prorf of the exterminator service provided.

Allegation investigated: Staff provided unprescribed medication to resident.

Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegation listed above. The LPA was greeted by staff and the staff contacted the Administrator on the phone. The LPA spoke with the Administrator on the phone Satenik Alajanyan and explained the reason for the visit. The Administrator stated they would come to the facility within 30 minutes. LPA Urena, along with the staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. LPA Urena interviewed staff at approximately 10:30 a.m. and Administrator at approximately 11:30 a.m. and requested records pertinent to the investigation. Continues on LIC 90999C... Substantiated On the allegation that staff provided unprescribed medication to residents (R1) in care; it is the concern of the reporting party that staff used medication which was not prescribed to R1, and that the medication belonged to another resident. To investigate the allegation, LPA Urena interviewed the RP on 10/13/2025 at approximately 11:47 a.m. Per the RP, the staff administered medication (two dosages of Lorazepam) which could have had severe complications given that R1 has dementia. LPA Urena interviewed R1’s responsible party and the interview revealed that staff informed them that on 10/10/2025, R1 had been constantly crying and agitated the night before and early morning and was disturbing other residents. The staff explained that they were desperate to calm down R1 and gave two tablets of the Lorazepam to R1. The interview with staff revealed that R1 had been getting anxious late at night, and during this time, R1 kept going into the other residents’ rooms, bothering them and not letting them sleep. This incident took place the night of 10/09/2025; it started late at around 11:00 p.m. and continued till next morning of 10/10/2025 until approximately 2:00 a.m.; this is when the staff administered the two pills during separate times because the first pill did not calm R1 down. The staff stated that they had informed the Administrator of the concern with R1’s agitation and bothering the other residents. On the morning of 10/10/2025, staff had a phone conversation with R1’s responsible party and informed them that they had given R1 the Lorazepam. Furthermore, the staff stated that they, and the responsible party for R1 had a three-way telephone conversation with R1’s primary physician at approximately 10:00 a.m. on the same day, and the staff explained to the physician what had happened the previous night . The interview with the Administrator revealed that they were aware of the incident. Record review revealed that R1’s primary physician prescribed two medications (Buspirone 5mg. 2xd, and Trazodone 50mg. as needed) to address the concerns of insomnia and agitation. The medications were filled on 10/10/2025, and per the Administrator the facility received them on 10/14/205. Staff started assisting with medications on the same day the medication was delivered. Based on the information obtained through interviews and record review, the allegation that staff provided unprescribed medication to R1, is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations (CCR), the following deficiencies were cited (refer to LIC 9099-D). Citations were issued. Interview exit was conducted. A copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 29-AS-20251011205324

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(2) · Plan of correction due date: Oct 17, 2025

87465 (a)(2)- Incidental Medical and Dental Care A plan for incidental medical and dental care shall be developed by each facility. The plan shall Encourage…medical…care and provide for assistance in obtaining such care, by compliance with the following: (1) the licensee shall arrange, or assist in arranging, for medical.. care appropriate to the conditions and needs of residents. (2) The licensee shall provide assistance in meeting necessary medical…needs… This requirement is not met as evidenced by: Based on information, and record review, the administrator did not assist in getting the appropriate care for R1’s agitation and crying, and by staff administering unprescribed medication to R1, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: Administrator agreed to provide medication training to staff from a qualified professional by the POC date and Administrator will review the cited regulation for understanding and submit proof to the department and LPA via email.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sandra Urena conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20251011205324). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation unrelated to the complaint. During today’s visit, LPA met with the Administrator and explained the reason for the visit. During the course of the investigation, it was discovered that Resident #1(R1) was given unprescribed medication on 10/10/2025. The LPA conducted facility data system review, and it revealed that the Licensee/Administrator did not submit an Unusual Incident Report (LIC 624). The unprescribed medication administered to the residents was not reported or communicated with the Department. Furthermore, in the course of the investigation, the LPA discovered Staff’s (S1) record review revealed that S1 did not have medication training on file. Pursuant to Title 22, California Code of Regulations and CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator 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 and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A-D) · Plan of correction due date: Oct 17, 2025

87211 Reporting Requirements (a) (1)(A-D) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below...... This requirement was not met as evidenced by: Based on record review and interview, the licensee failed to comply with the section cited above as the facility failed to submit written reports as required, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: The Administrator shall review Regulation 87211 and submit a written memo of understanding of the regulation to CCL and LPA Urena by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.69(b) · Plan of correction due date: Oct 17, 2025

(b) Each to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as S1 didnot have medication training on record, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: Licensee will schedule an approved vendor or certified medical professional to conduct a medication training for all facility staff, including management. Proof of scheduled training will be sent to CCL by POC due date. Proof of training to include documentation of training topics covered, duration of training, trainer information, and attendees will be sent to LPA upon completion by due date.

Allegation investigated: Lack of supervision resulting in resident eloping from the facility.

Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegation listed above. The LPA was greeted by the staff. The staff contacted the Administrator on the phone. The LPA explained the reason for the visit to the Administrator Satenik Alajanyan over the phone. The Administrator stated that due to personal reasons, they were unable to come to the facility at this time and asked the LPA to go over the allegation. LPA Urena, along with the staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and that the facility is in compliance with Title 22 Regulations. LPA Urena interviewed the Administrator and staff from approximately 10:55 a.m. and 11:25 a.m. Requested records pertinent to the investigation, and reviewed records from approximately 11:56 to 12:39 p.m. Continues on LIC 9099C... Substantiated Lack of supervision resulting in a resident eloping from the facility. On the allegation that lack of supervision resulted in a resident (R1) eloping the facility, it is the concern of the RP that R1 was found wandering the streets on 08/19/2025, was picked up by Los Angeles Fire Department and transferred to a medical facility for observation and care. LPA Urena interviewed the RP, and the interview revealed that R1 stated that they have left the board and care facility at least three (3) prior times and the staff usually finds them, and R1 goes back with staff. The Administrator’s interview revealed that they were aware that R1 had eloped the facility, and that they had not reported the incident to the Community Care Licensing Division (CCL) because the Social Worker for R1 had contacted them within 48 hours. The Administrator stated that R1 had eloped on Thursday 08/21/2025. The LPA interviewed the staff (S1) and S1 stated that R1 had eloped on Tuesday (08/19/2025). The staff stated that they noticed that R1 had eloped the facility on 08/19/2025 between 6:00 p.m. and 7:00p.m., was not sure of the specific time, but knew it was before dinner. S1 did not see R1 leave the facility. S1 stated that they were assisting another resident, and after they finished assisting the other resident, they realized that R1 was gone. Per S1, R1 exited the facility through the side gate, which the R1 knows how to deactivate the signal system. S1 stated that R1 has attempted to elope before, but they usually catch R1 and stop them by redirecting R1 back to the facility. Furthermore, S1 stated that they informed the Administrator right away after they noticed that R1 was gone and could not find them. LPA was able to obtain the contact number for the SW and reached out to them. Per the SW, they are not R1’s SW, they work for a health care center where R1 was previously admitted. Record review of LIC 602 (Physician’s Report) reveals that R1 cannot leave the facility unassisted. Based on the information obtained through interviews and record review, the allegation that staff’s lack of supervision resulted in R1 eloping from the facility, is deemed to be Substantiated at this time. The following deficiency was observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiency may result in civil penalties. Citations were issued. Exit interview was conducted with Amy Vetinyan, the Administrator's acquaintance due to the Administrator being unavailable via person or telephone. The Administrator allowed the staff to sign off on the report. A copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 29-AS-20250821122539

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Aug 29, 2025

87464(f)(1) Basic Services. Basic services shall at a minimum include: Care and Supervision. This requirement was not met as evidenced by: 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 facility failed to ensure that R1 did not leave the facility unassisted per the physician report, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 25, 2025

Plan of correction: The Administrator shall review Regulation and will submit a plan of action on how the elopement of residents will be prevented and action plan to be followed if the event a resident elopes the facility to CCL and LPA Urena by POC date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sandra Urena conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-29-AS-20250821122539). The purpose of the visit is to issue citations for the deficiencies observed during the initial complaint investigation unrelated to the complaint. During today’s visit, LPA spoke with the Administrator Satenik Alajanyan and explained the reason for the visit. During the course of the investigation, it was discovered that the Administrator had not submitted an Incident Report to the Community Care Licensing Department to inform them of the elopement of R1 on 08/19/2025. The Administrator stated that they were contacted by a Social Worker (SW),( Administrator did not know full name of SW or agency affiliation) on Thursday 08/21/2025, letting them know that R1 was at the hospital. The Administrator stated that because the SW informed them that R1 was in the hospital, the Administrator did not consider it necessary to send the LIC 624 to CCL. Furthermore, in the course of the investigation, the LPA discovered that R1’s file had incomplete forms (LIC 602) Medical Assessment: (LIC 602) - Missing Physician’s diagnosis, no phone number. No contact phone number for the physician and Staff’s (S1) record review revealed that S1 did not have a CPR and First Aid certificate on file. Pursuant to Title 22, California Code of Regulations and CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Citations were issued. Exit interview was conducted with the Amy Vetinyan, the Administrator's acquaintance due to the Administrator being unavailable via person or telephone. The Administrator allowed the staff to sign off on the report. A copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Aug 25, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(c)(1)(2) · Plan of correction due date: Aug 29, 2025

87411(c)(1)(2) (c)All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified … (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. (2) This training shall be administered on the job, in a classroom setting, or any combination of the two. This requirement was not met as evidenced by: Based on interview and records review, the licensee did not comply with the section cited above, as the facility failed to ensure that S1 obtained a CPR/First Aid Training, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 25, 2025

Plan of correction: Administrator will ensure that staff completes CPR and First Aid training by POC date, and will email LPA proof/certificate of completion.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(A-D) · Plan of correction due date: Aug 29, 2025

87211 Reporting Requirements (a) (1)(A-D) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below...... This requirement was not met as evidenced by: Based on record review and interview, the licensee failed to comply with the section cited above as the facility failed to submit written reports as required, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 25, 2025

Plan of correction: The Administrator shall review Regulation 87211 and submit a written memo of understanding of the regulation to CCL and LPA Urena by POC date.

Allegation investigated: Staff did not prevent resident from leaving the facility unassisted Staff did not notify resident's responsible party of the relocation of resident.

Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above listed allegations. Upon arrival approx at 9:30 am, LPA Mosley was greeted by Staff Iuliia Palchikova who called the Administrator to inform them of the visit. The Administrator was unable to attend and designated staff Iuliia Palchikova to sign the report. LPA met with caregiver Iuliia Palchikova and the reason for the visit was explained. Entrance interview conducted. On 06/11/2025, the Department received a complaint regarding the following allegations, Staff did not prevent resident from leaving the facility unassisted and Staff did not notify resident's responsible party of the relocation of resident. LPA and staff toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations. Report continued on LIC 9099-C PAGE 2... Unsubstantiated (PAGE 2) Report continued from LIC-9099-C... During today’s visit, starting at 9:30 a.m. LPA and staff conducted a physical plant tour to ensure there are no immediate health and safety concerns and facility is in compliance with Title 22 Regulations, at 9:35 a.m. conducted a brief telephonic interview with the Administrator and reconducted the telephonic interview at 11:35 a.m. starting at 9:57 a.m. conducted in-person interviews with one (1) staff member / care giver, starting at 10:15 a.m. conducted in person interviews with three (3) residents and two (2) family members who were visiting, starting at 10:42 a.m. conducted a file review, and obtained copies of pertinent documents relevant to the investigation, At 11:28 a.m. two (2) attempted phone calls and voicemail were left for the facility office staff, starting at 12:26 p.m. conducted telephonic interviews with two (2) relocation site facility Administrators. On the allegation Staff did not prevent resident from leaving the facility unassisted it is the concern of the Reporting Party (RP) that approx. around June 2025 Resident #1 (R1) had wandered out the facility. To investigate this complaint, on 06/13/25 at 1:36 p.m., 06/18/2025 at 8:30 a.m. LPA conducted a telephonic interview with the Los Angeles County Public Guardian (LACPG) on 06/17/2025 at 3:29p.m. conducted a telephonic interview with Family Member (FM) of R1, 06/19/25 starting at 9:35 a.m. conducted a brief telephonic interview with the Administrator and reconducted the telephonic interview at 11:35 a.m. starting at 9:57 a.m. conducted in-person interviews with one (1) staff member / care giver, starting at 10:15 a.m. conducted in person interviews with three (3) residents and two (2) family members / visitors, who were visiting a resident, starting at 10:42 a.m. conducted a file review, and obtained copies of pertinent documents relevant to the investigation, at 11:28 a.m. two (2) attempted phone calls and voicemails were left for the facility office staff. Telephonic interview with LACPG revealed that on 06/10/2025 they were informed that R1 was wandering however no specific details were given or provided. Interview with FM revealed that they are unaware of R1 leaving the facility unattended or unassisted. Interview with the Administrator revealed that R1 was only at the facility for two (2) to three (3) days max and in that time R1 wandered around the facility grounds however never wandered out of the facility. Interview with caregiver revealed that R1 was briefly at the facility one (1) to two (2) days and wandering around the kitchen in desire to cook food. R1 never left the facility unassisted by staff. R1 remained on the facility grounds supervised. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC-9099-C... Interviews with residents revealed that they are unfamiliar with R1 however recall hearing the name but no concrete information could be provided with certainty. Residents have never seen any of the other residents wander out the facility unattended or without staff knowledge. The staff would not allow the residents to leave the facility unattended. Interview with family visitors revealed that they have not witnessed any of the residents leave the facility unattended. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff did not prevent resident from leaving the facility unassisted is deemed unsubstantiated at this time. On the allegation Staff did not notify resident's responsible party of the relocation of resident it is the concern of the of the Reporting Party (RP) that approx. around June 4th -8th 2025 Resident #1 (R1) was relocated to a facility in Hemet, Riverside County without informing the family. To investigate this complaint, on 06/13/25 at 1:36 p.m., 06/18/2025 at 8:30 a.m. LPA conducted a telephonic interview with the Los Angeles County Public Guardian (LACPG), on 06/17/2025 at 3:29p.m. conducted a telephonic interview with Family Member (FM) of R1,on 06/19/25 starting at 9:35 a.m. conducted a brief telephonic interview with the Administrator and reconducted the telephonic interview at 11:35 a.m. starting at 9:57 a.m. conducted in-person interviews with one (1) staff member / care giver, starting at 10:15 a.m. conducted in person interviews with three (3) residents and two (2) family members who were visiting, starting at 10:42 a.m. conducted a file review, and obtained copies of pertinent documents relevant to the investigation, At 11:28 a.m. two (2) attempted phone calls and voicemail were left for the facility office staff, starting at 12:26 p.m. conducted telephonic interviews with two (2) relocation site facility Administrators. Telephonic interview with LACPG revealed that on 06/10/2025 they were informed that R1 had been transferred to another facility for the safety of the resident. LACPG asked the facility if they had notified the family of the relocation of R1 and was informed by the facility to contact the family directly. Interview with FM revealed that they have do not have any authority, power of attorney (POA) conservatorship or signing rights for R1. FM is unfamiliar and unaware if R1 was at the facility or not, however was under the impression that R1 was rejected by the facility. FM called the facility and was informed that they did not have any resident with R1’s name. Interview with the Administrator revealed that R1 had been dropped off at the facility, exact date unknown without any knowledge or prior approval. Report continued on LIC 9099-C PAGE 4... (PAGE 4) Report continued from LIC-9099-C... R1 arrived during the evening with nothing, no paperwork, documents or contact information for family. Administrator facilitated the relocation of R1 to a facility in Hemet, Riverside County. On 06/10/2025 Administrator was contacted by LACPG for the whereabouts of R1. Administrator informed LACPG that R1 was transferred, and they had no contact information for R1. Interview with caregiver revealed that R1 was briefly at the facility one (1) to two (2) days the exact date is unknown. R1 was dropped off by a transportation service from Kaiser with out any prior approval. R1 arrived with a green bag containing medications, change of clothing and paperwork that gave instructions on medications. The paperwork provided did not contain any information for R1, it did not have any contact information, or the list of medications R1 was on. The following day R1 was transferred to the facility in Hemet. Interviews with residents revealed that they are unfamiliar with R1 however recall hearing the name but no concreate information could be provided with certainty on R1. Interview with family visitors revealed that they are unaware and unfamiliar with R1 and have no knowledge of R1. Interview with Hemet facility Administrator (HFA) reveled that R1 had been dropped of at their facility on 06/04/2025 with no paperwork or belongings other than a LIC 602 Physician Report and a Kaiser face sheet with no contact information on it. HFA was later contacted by Adult Protective Services (APS) who provided more information regarding R1 and at that time provided contact information. R1 was transferred back to Kaiser with the knowledge of LACPG and FM for proper placement of R1. Interview with relocation site (RS) revealed that R1 was transferred to their facility on 06/17/2025 with a discharge summary. R1 is under the care and supervision of a licensed facility with LACPG and FM knowledge of their whereabouts. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur due to facilities not having any contact information or proper information for R1's family, LACPG, or emergency contact. Therefore, the allegation of Staff did not notify resident's responsible party of the relocation of resident is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 29-AS-20250611115806

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced CASE MANAGEMENT visit to this facility in conjunction with a complaint. The purpose of this Case Management visit is to issue citations for deficiencies discovered during the course of the complaint investigation that is not directly related to the complaint allegation. During today’s visit, LPA spoke with Staff / caregiver Iuliia Palchikova who called the Administrator to inform them of the visit. The Administrator was unable to attend and designated staff Iuliia Palchikova to sign the report. LPA explained the reason for the visit. During interview with Staff #1 (S1) revealed that sometime time early in June 2025 the exact date is unknown the facility was over capacity and had seven (7) residents. LPA observed the facility license which state that the facility’s total capacity is six (6). Facility does not have fire clearance for more than six (6) clients. File review conducted at 10:42 a.m. revealed that all six (6) current residents residing at the facility had an admission date prior to June 2025. Interview with S1 revealed that Resident #1 (R1) was brought to the facility sometime early in June 2025 the exact date is unknown via transportation service from Kaiser. S1 noted that they were unaware why the resident was brough to the facility as they were at full capacity with six (6) residents however still allowed the resident to stay which poses / posed an immediate health, safety or personal rights risk to persons in care. LPA discussed section Title 22 section 87202 Fire Clearance, 87204 Limitations - Capacity and Ambulatory Status and the importance of not operating a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. Report continued on LIC809-C... (PAGE 2) Report continued from LIC 809... Interview also revealed that the facility accepted R1 without any proper documentation including preadmission appraisal and all the proper documentation needed prior to acceptance which poses / posed an immediate health, safety or personal rights risk to persons in care. LPA discussed the importance of Title 22 requirements for proper documentation and assessments needed prior to accepting residents. Furthermore, LPA discussed the Regulations regarding Eviction Procedures for RCFE stated Thirty (30) days written notice to the resident is required for California Code of Regulations (CCR) Section 87224(a)(1) through (4). These are nonpayment of the rate for basic services, failure to comply with state or local law, failure to comply with the general policies of the facility, and development of a resident need not previously identified. Sixty (60) days written notice is required for Section 87224(a)(5). This is the eviction of a resident due to change of use of the facility. 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. Civil penalty was assessed in the amount of $500 for fire clearance violation. Administrator was informed that failure to correct the deficiency may result in additional civil penalties. Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Jun 19, 2025

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions... the license, including specification of the maximum number of persons...This requirement is not met as evidenced by: Based on interviews, and file review the licensee did not comply with the section cited above as the facility admitted Residnet #1 (R1) while at full capacity which poses / posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 19, 2025

Plan of correction: Administrator stated R1 was relocated, will review regulation, and ensure they will not allow any residents when they are at full capacity.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87457(b) · Plan of correction due date: Jun 19, 2025

87457 Pre-Admission Appraisal (b) No person shall be admitted without his/her consent and agreement, or that of his/her responsible person, if any. This requirement is not met as evidenced by Based on interviews, and file review the licensee did not comply with the section cited above as the facility admitted Resident #1 (R1) without proper documentation which poses / posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 19, 2025

Plan of correction: Administrator stated R1 was relocated, will review regulations and ensure they will not accept residents when they do not have all the proper documentation.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility announced to conduct a follow up pre-licensing inspection. The LPA met with Applicant Satenik Alajanyan. This is a Residential Care Facility for the Elderly (RCFE) application for a Change of Ownership (CHOW) from Prime Senior Living F# 195850263 to All Star Living Inc. F#195850586. The current capacity is for six (6) elderly ambulatory residents, the facility currently has two (2) residents. The fire clearance was granted on 12/11/2024 for Ambulatory residents Only. The ADU observed in the back of the property was not included in this Fire clearance.Pre-Licensing is complete, and deficiencies were resolved. · The following postings are missing Residents Rights (LIC 613), and the Emergency Disaster Plan (LIC610E) will need to be updated to reflect staff responsibilities in case of an emergency. · The fire extinguisher is mounted on the wall by the kitchen area; however, the fire extinguisher did not have a receipt of purchase. · Bedroom #4 needs a closet installed for resident’s clothes. · The private’s bathroom wall has a dent/hole on the wall which needs to be repaired. · The hot water temperature in the bathroom measured 130.1 degrees Fahrenheit. · On the left-hand side of the house, there are two open areas on the ground that will need to be covered to prevent residents from falling in. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted with applicant, and the report was issued.the state’s words, verbatim · CDSS document, Mar 19, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility announced to conduct a pre-licensing inspection. The LPA met with Applicant Satenik Alajanyan. This is a Residential Care Facility for the Elderly (RCFE) application for a Change of Ownership (CHOW) from Prime Senior Living F# 195850263 to All Star Living Inc. F#195850586. The current capacity is for six (6) elderly ambulatory residents, the facility currently has two (2) residents. The fire clearance was granted on 12/11/2024 for Ambulatory residents Only. The ADU observed in the back of the property was not included in this Fire clearance. The LPA and the applicant toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. The common areas, walls, flooring and furniture were checked for cleanliness and were found to be in good condition. Some of the required postings were observed on a board on the wall next to the kitchen area; however, the following postings are missing Residents Rights (LIC 613), and the Emergency Disaster Plan (LIC610E) will need to be updated to reflect staff responsibilities in case of an emergency. Emergency exiting plans/sketch are posted on the same board. KITCHEN: Kitchen knives are stored locked, and inaccessible to residents in a kitchen cabinet. The supply of perishable, and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were clean, and all appeared functional. There is an adequate supply of emergency food. The fire extinguisher is mounted on the wall by the kitchen area; however, the fire extinguisher did not have a receipt of purchase, the applicant explained that it was purchased in 2024, however, the date of the purchase could not be determined. The applicant will look for receipt or may purchase a new fire extinguisher. LAUNDRY: Washer and dryer are located in the kitchen area. Continues on LIC 809C... BEDROOMS: The facility has (4) bedrooms, all bedrooms are resident bedrooms. No staff bedroom was available. Bedrooms #1 and #4 are single occupancy, bedrooms #2 and bedroom #3 are shared rooms. Bedroom #4 needs a closet installed for resident’s clothes. All residents’ bedrooms are furnished appropriately with clean linens, furnishings, and sufficient lighting. BATHROOMS: There are two (2) full bathrooms. One is a private bathroom in bedroom #1, and the second bathroom is located in the hallway. The private’s bathroom wall has a dent on the wall which needs to be repaired. The shower is equipped with nonskid mats. Grab bars were observed in the bathroom. The hot water temperature in the bathroom measured 130.1 degrees Fahrenheit. MEDICATIONS: Medications are stored in kitchen cabinet that was observed to be locked during the visit and was observed to be locked and inaccessible to residents in care. The first aid supplies were complete, including a first aid manual, and is located inside a cabinet by the kitchen area. FILES: Resident and staff records are stored in a file cabinet located in a corner of the common area between the dining room and the living room area. EXTERIOR: The exterior passageways were clean, and clear of any obstructions. There is a covered patio area on the side yard with a sitting area for residents’ use. On the left-hand side of the house, there are two open areas on the ground that will need to be covered to prevent residents from falling in. ADU: An additional dwelling unit was observed in the rear of the property, which can be accessed by residents and staff. The ADU was vacant at the time of the visit. Per the applicant they plan to submit an application for another facility license for this ADU. The applicant stated that it would be under the name of the current applicant. The LPA advised the applicant that no other people (not affiliated the facility/and/or background cleared) can live in the ADU. Continues on LIC 809C... Pre-Licensing is incomplete with deficiencies to be resolved by 3/21/2025. Follow up Pre-licensure LIC809 will be generated upon resolution. · The following postings are missing Residents Rights (LIC 613), and the Emergency Disaster Plan (LIC610E) will need to be updated to reflect staff responsibilities in case of an emergency. · The fire extinguisher is mounted on the wall by the kitchen area; however, the fire extinguisher did not have a receipt of purchase. · Bedroom #4 needs a closet installed for resident’s clothes. · The private’s bathroom wall has a dent/hole on the wall which needs to be repaired. · The hot water temperature in the bathroom measured 130.1 degrees Fahrenheit. · On the left-hand side of the house, there are two open areas on the ground that will need to be covered to prevent residents from falling in. Applicant completed Component III at 02:05 p.m. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted with applicant, and the report was issued.the state’s words, verbatim · CDSS document, Mar 4, 2025