Amerihome

Allegation investigated: Staff did not prevent resident from developing multiple pressure injuries while in care. Resident sustained an unexplained injury while in care.

On 05/28/2026, Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to deliver findings for the allegations 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, and explained the reason for the visit. The Administartor stated they were away at an appointment, and agreed to have the report over the phone. On 04/30/2025, the CCL department received a complaint about the allegations listed above. On 05/01/2025, Licensing Program Analyst (LPA) Sandra Urena arrived at the facility and made an unannounced visit to investigate the allegations listed above. LPA Urena interviewed the Administrator, the staff, and residents and requested records relevant to the investigation. On 05/18/2026, the LPA conducted an interview with the Home Health nurse. Continues on LIC 9099C...2 Unsubstantiated 2.Staff did not prevent resident from developing multiple pressure injuries while in care. It is alleged that the resident (R1) developed unstageable pressure injuries on their mid back, left heal, scapula, right thigh sacral area, and a deep tissue injury on the right heel while residing at the facility. LPA Urena interviewed the R1’s Representative (R), and the interview revealed that R1 had a pressure wound above the coccyx area when R1 was admitted to the facility. R reported that R1 stopped eating and drinking before December 2024 and had lost weight but did not say how much weight. R was dissatisfied with the care facility staff were providing to R1 such as not brushing R1’s teeth, not celebrating “anything”, not allowing them to see when facility staff changed R1’s diapers. Furthermore, the R reported that R1 was receiving Home Health services for the pressure wound. No other reports of pressure injuries were reported by the R during the interview. Interview with the Administrator revealed that R1 was admitted to the facility on 07/31/2024 with significant skin integrity issues and a history of skin breakdown. The facility immediately implemented frequent incontinence care, repositioning, hygiene assistance, and monitoring, while Home Health (HH) services were involved for wound assessment and ongoing care starting on 08/01/2024. The HH nurse visited the facility twice daily to monitor R1’s medical condition, perform body assessments, monitor skin integrity, and provide wound care follow-up and recommendations to facility staff. Interview with staff revealed that they were following HH nurse’s instructions on how to care for R1’s skin, by repositioning R1 in bed and using supporting pillows. Interview with the HH nurse revealed that R1 was admitted to the facility on 07/31/2024 with pressure wounds at Stage1 and Stage 2, and HH began proving services to R1 at the facility on 08/01/2024. Per HH nurse, facility staff followed all instructions for wound care, observed that the wound dressings were always clean, and observed staff to be caring when taking care of R1. HH nurse reported that R1 was hospitalized in September of 2024 for a UTI, and when R1 returned to the facility, R1’s skin breakdown was in worse condition. Furthermore, HH nurse reported that R1’s wound condition would fluctuate due to being bedbound. HH continued services for R1 until 02/03/2025, when R1 was admitted to the hospital. Continues on LIC 9099C...3 3. LPA Urena conducted record review of documents pertaining to the investigation: Record review of Valley Village Care Center (VVCC), indicated that R1 was admitted to the VVCC on 02/05/2024 and discharged on 07/31/2024. On date of discharge, R1 was weighing 112.0 lbs. Record review of the Physician’s Report dated 02/07/2024 listed as Primary Diagnosis: Metabolic Encephalopathy, and secondary diagnosis as hand stiffness, dysphasia, ESBL resistance, anemia, COPD, dementia, depression and sleep disorder. Record review of Distinctive Home Health (DHH) records dated 07/31/2024 indicated that DHH conducted a full assessment of R1. The DHH care plan indicated a certification period of: 08/01/2024 to 09/29/2024. Active Diagnosis: Type 2 Diabetes mellitus with other skin complications; Hypertensive heart disease, Pressure ulcer of Buttock, Stage 2.; Pressure ulcer of Right buttock, Stage 1., Alzheimer's disease. Wound Care: Pressure ulcer of buttock, Stage 2., Pressure ulcer of Right buttock, Stage 1. Multiple scattered redness on bilateral buttocks areas. The patient has multiple skin issues/impairment during skin assessment. Record review of Care Plans dated 2/01/2025, 02/02/2025, and 02/03/2025, indicated that R1 was receiving wound care for two pressure wounds. Wound #1- Location: coccyx; Status-open; Onset Date: 02/01/2025, Type: Pressure Injury, Stage 3; Length: I cm.; Width: 0.8cm; Depth 0.2 cm. Drainage: None, Odor: None Wound #2- Location: lower back; Status-Open, Onset Date: 02/01/2025, Type: Pressure Injury, Stage 3; Length: 1cm, Width: 1cm; depth: 0.1 cm. Drainage: None Odor: None Record review of medical records from Northridge Hospital dated 09/14/2024, indicated that R1 was admitted to the hospital for UTI. R1 was given a physical examination, and the following areas were observed: Abdomen-soft, nondistended; Extremities-no cyanosis, clubbing or edema. No report of multiple pressure injuries was noted during the physical exam. At time of admission R1 was weighing 140.0 lbs. Record review of the Pre-Admission Medical Report requested by Los Angeles Jewish Health (SNF) as a pre-admission requirement to admit R1 to their health center, was signed and dated by R1’s physician on 01/25/2025. No report of multiple pressure injuries was noted. Furthermore, the Comments section indicates the following: “Patient needs help with basic ADLs such as bathing, dressing, grooming, toileting, eating, transferring, meal preparation, housekeeping”. Record review of the medical records from Mission Community Hospital dated from 02/03/2025 to 02/14/2025: Admission and Discharge papers indicated that R1 was admitted to the ER presenting hypotensive and altered mental status from baseline following diarrhea. The Admitting Diagnoses dated 02/03/2025: were Sepsis, UTI and dementia. Continues on LIC 9099C...4 4. A Focused Exam was conducted and listed the following: Cardiopulmonary exam: Rate and rhythm normal, heart sounds normal; Peripheral Pulses: normal; Skin Exam: Skin warm, normal in color, dry. Furthermore, a Pertinent Physical Exam was also conducted at the time of admission to the hospital in the areas: Head, eyes, neck, chest, abdomen, upper and lower extremities. No indication of pressure wounds were observed during the exam. However, Discharge Summary dated 02/14/2025, indicated that R1 was treated with antibiotics for infections noted at arrival. Furthermore, the discharge report indicates that R1 was discharged with the following: Povidone-iodine (Betadine) Solution 10%-Cover area daily-Notes: L-trochanter, R-lower back, L-posterior arm, bilateral heel, L-medial and lateral Malleolus pressure injury. Therahoney Gel 42.5 gram (thin layer twice a day)-Notes: Sacrococcyx and lower midback pressure injury: cleanse with NS, pat dry, apply Therahoney gel cover with dressing twice a day. R1 was awaiting placement to be discharged to a Skilled Nursing Facility (SNF) and on 02/14/2025 R1 was admitted to Alameda Care Center. Based on record review and interviews, the resident was admitted to the facility with existing pressure wounds; furthermore, record review indicates that the home health nurse oversaw the wound care of the resident and provided training and guidance to the facility staff on how to reposition the resident, and the use of adaptive implements. Interviews indicated that facility staff followed the care plan. Therefore, the allegation that staff did not prevent pressure wounds from developing while in care, is deemed Unsubstantiated at this time. Although, a deficiency pertaining to pressure injuries will be cited under separate cover. Resident sustained an unexplained injury while in care. On the allegation that the resident sustained an unexplained injury while in care, it was the concern of the Reporting Party (RP), that they observed purple discoloration, which appeared to be a bruise on R1’s back; however, the RP stated that they were not sure how the resident was bruised on their back. To investigate the allegation, the LPA attempted to interview the RP to obtain additional information as to the exact location and size of the bruise; however, the LPA was unable to communicate with the RP. LPA Urena interviewed R1’s representative, staff, Administrator, and home health nurse about the alleged injury/bruise on R1’s back. Interviews revealed that they had not observed nor were they aware of a bruise on R1’s back. Although the allegation may have happened or is valid, based on the interviews, there is not sufficient evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time. The Administrator allowed the facility designated staff to sign the report on their behalf. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, May 28, 2026 · control 29-AS-20250430153711

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-20250430153711). The purpose of the visit is to issue citations for deficiencies observed during the initial complaint investigation unrelated to the complaint. The LPA was greeted by staff and the staff contacted the Administrator on the phone. The LPA spoke with the Administrator on the phone, and explained the reason for the visit. The Administrator stated they were away at an appointment, and agreed to have the report read over the phone. During record review of complaint investigation control #29-AS-20250430153711, care plan records reflect that starting on 02/01/2025, R1 was diagnosed with two (2) -Stage 3-pressure wounds, which is a prohibited health condition and licensee retained the resident with this condition until they were hospitalized on 02/03/2025 for an unrelated issue. 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. The Administrator allowed the facility designated staff to sign the report on their behalf. Exit interview conducted, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 28, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615 · Plan of correction due date: Jun 5, 2026

(a) (1)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 record review, the licensee did not comply with the section cited above as one (1) resident retained in a residential care facility for the elderly with a Stage 3 pressure wound, which poses an immediate/potential.. health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 28, 2026

Plan of correction: The Licensee will provide written plan of action explaining how she is going to assure that the residents who developed prohibited health condition will not be retained at the facility.The documentation must be submitted to the LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. The LPA were greeted by staff and informed them of the reason for the visit. The staff contacted the Administrator to inform them of the visit. The Administrator Jasmin Sargsyan arrived shortly thereafter. The LPA and the staff 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 AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 07/29/2025. The LPAs observed required postings throughout the common space. KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at 114.1 degrees Fahrenheit. BEDROOMS: The facility has five (5) residents’ bedrooms and one (1) staff bedroom. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There was a linen closet in the hallway next to the kitchen area and in between bedrooms # 4, and #5, with extra towels and linens. All rooms were observed to be clean. The staff’s bedroom was observed to be locked at the time of the inspection. Bedrooms’ #1, #2, #3 need a new exit ramp installed outside the sliding glass doors leading to the back outdoor area. Continues on LIC 809C... BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels, grab bars, non-skid mats, and trashcans with tight-fitting lids. Handwashing signs were posted. The hot water temperature measured in the restrooms at 115.1 degrees Fahrenheit. LAUNDRY ROOM: The washer and dryer are in a room adjacent to the kitchen. All cleaning liquids and materials are locked in a cabinet above the washer and dryer. The facility has an attached garage. The door leading to the garage was locked at the time of the visit. OUTDOOR AREA: The backyard has a shaded area with outdoor furniture No bodies of water noted. The wooden fence on the right side of the property needs to be repaired. The Administrator stated that they are working with the next-door neighbor to come into an agreement to replace the fence and split the cost. However, the wooden fence in need of repair is only on the side of the facility, and the neighbor’s fence appears to be in good condition. Administrator stated that they will have the wooden fence on the side of the facility removed within two weeks of today's visit, till they decide the type of fence that will be installed. Removal of the facility fence will not pose a danger to residents in care. RECORDS: Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:41p.m. Medications are centrally stored and locked in the medication room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability - Emergency Drills No citations were issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena and Quoc Huynh arrived at the facility unannounced to conduct a required annual inspection. The LPAs were greeted by staff and informed them of the reason for the visit. The staff contacted the Administrator to inform them of the visit. The Administrator Jasmin Sargsyan arrived shortly thereafter. The LPA 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 AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The two (2) fire extinguishers were fully charged and were last serviced 2/7/2025. The LPAs observed required postings throughout the common space. KITCHEN: Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The hot water temperature measured at 114.1 degrees Fahrenheit. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are three designated client rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. Handwashing signs were posted. The hot water temperature measured in the restrooms at 115.1 degrees Fahrenheit. Continues on LIC 809C... OUTDOOR AREA: The backyard has a shaded area with outdoor furniture No bodies of water noted. The washer and dryer are in a room adjacent to the kitchen. All cleaning liquids and materials are locked in a cabinet above the washer and dryer. RECORDS: Records review began at 11:30 a.m., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:41p.m. Medications are centrally stored and locked in the medication room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. 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 COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability - Emergency Drills No citations were issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 12, 2025

Allegation investigated: Staff yells at resident

Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit to deliver findings for the above allegation. Upon arrival, LPA met with caregivers Irina Safaryan and Marieta Kirakosyan. Caregiver Irina contacted the Administrator by phone, Jasmine Sargsyan, and subsequently transferred the call the LPA. LPA explained the reason for the visit, moreover, Administrator informed the LPA that she would not be able to be present to the reading of findings. Administrator requested a conference call between her and her caregivers at the time LPA will read report. Additionally, Administrator authorized caregiver, Irina, to sign today's report. At 11:10 am LPA along caregiver Marieta 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. At 11:35 a.m. caregivers contacted Administrator so LPA can read report findings. Continued on LIC 9099-C Substantiated Continued from LIC 9099 Entrance interview conducted. It was alleged that facility staff yell at residents. It was further reported that unknown staff member yells at residents to “shut up, be quiet and go to your room”. On 05/30/2024, LPA Conway conducted the initial visit. During the visit, at 10:01 a.m. LPA conducted a physical plant tour; as well, as interviewed five (5) residents, staff and administrator. Additionally, LPA requested and reviewed facility documentation pertinent to this investigation. Interviews conducted during the course of the investigation reflected that three (3) out of the five (5) residents interviewed have witnessed Staff #1 (S1) yell at residents on multiple occasions. The other two (2) residents interviewed revealed they have not witnessed staff yell at any resident, but they stated that the aggressive and stern manner S1 speaks to residents could be observed as verbal abuse. LPA's interviews with S1 denied yelling at any resident in care. LPA’s interview with Administrator revealed they have not witnessed S1 yell or mistreat any resident in care but expressed that it may be S1’s mannerisms of speaking loudly and “talking with their hands” that may make it appear S1 is yelling at residents in care. Based on the information obtained through the course of the investigation, there is sufficient evidence to support the allegation “Staff yelled at resident.” Therefore, this allegation is deemed Substantiated at this time. Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 9099-D). Exit Interview Conducted. Failure to correct the deficiencies may result in civil penalties. Appeal Rights Discussed. A Copy of Report Issued. Exit interview was conducted with the administrator. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 21, 2024 · control 29-AS-20240529090218

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jul 5, 2024

87468.1(a)(1) Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall... personal rights: (1) To be accorded dignity in... relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews, licensee did not comply with the above section by staff # 1 not according dignity to residents in care which is a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 21, 2024

Plan of correction: Licensee will provide training on working with individuals with behavioral issues. Licensee will counsel S1 on treating residents with dignity and respect and review regulation cited. Licensee will send CCL the training sign-in sheet, signed by staff by 07/05/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today at 12:30PM. The last annual conducted at this facility was on 02/03/2023. When the LPA arrived, there were two (2) staff and six (6) residents present. The LPA met with staff and advised them of the visit. Staff called the Administrator, and at this time, the reason for the visit was explained. The Administrator, Jasmine Sargsyan arrived at 1:15PM. Entrance interview. At 1:17PM, the LPA along with 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. The following was noted: KITCHEN: The LPA inspected the kitchen/food service area at 1:28PM. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. The knives and sharps are stored in a locked drawer inaccessible to residents in care. At 1:33PM, the hot water temperature was measured in the kitchen sink, and it measured 114.9 degrees Fahrenheit. COMMON AREAS: At the time of the visit, the living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. At 1:40PM, the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed to be in compliance and newly purchased on 07/26/2023. Continued on LIC 809C... Continued from LIC 809... The LPA observed required postings throughout the common space. Night lights were present in the hallways. Auditory alarms were observed working at the time of the visit. There is a working telephone on premises. LAUNDRY ROOM: LPA observed a laundry room with a washer and a dryer. Laundry detergents were observed inside a locked cabinet in the laundry room. OUTDOOR AREA: The backyard has a covered patio area equipped with furniture for resident use. Emergency exits and passageways were observed free of obstruction. There were two (2) side gates with self-latching mechanisms. No bodies of water were noted at the time of the visit. GARAGE: The garage is attached and observed locked at the time of the visit. There is one (1) additional refrigerator with perishable food in good condition. LPA observed additional Personal Protection Equipment (PPE). Extra cleaning supplies were observed inaccessible to residents. BEDROOMS: There are five (5) resident bedrooms and one (1) staff bedroom. The LPA observed the resident bedrooms to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) resident restrooms. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with liquid soap and paper towels; towels and washcloths are not shared. The hot water temperature was measured in all bathrooms; the first bathroom measured 114.4 degrees Fahrenheit at 1:18PM; the second bathroom measured 118.0 degrees Fahrenheit at 1:20PM; and the third bathroom measured 112.4 degrees Fahrenheit at 1:26PM. RECORDS: Records review began at 1:56PM; six (6) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All records were in order. Continued on LIC 809C... Continued from LIC 809C... Two (2) personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were complete. The current Administrator’s file was also reviewed, and it was complete. Administrator’s certificate is active and expires on 01/07/2025 At the time of the visit, LPA obtained copies of current LIC 500, Infection Control Plan, and Limited Liability Insurance. The last emergency disaster drill took place on 12/12/2023. MEDICATIONS: Medications review began at approximately 3:10PM; medications are centrally stored in a locked closet by Room #1. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications are properly documented on the centrally stored medications and destruction record. Exit interview conducted. No deficiencies cited. Report was reviewed and a copy was issued.the state’s words, verbatim · CDSS document, Mar 10, 2024