Angel Life Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an Annual Required visit and inspection of the facility. LPA met with Administator - Michael Petrosian and explained the reason for the visit. The facility is licensed to serve Elderly residents ages 60 and above with developmental disabilities Facility is approved to serve (6) Non-Ambulatory residents, of which (6) may be Bedridden, with hospice waiver for (6) The home is vendorized by Frank D. Lanterman Regional Center. At 11:45am, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the hallway. The smoke and carbon monoxide detectors are hardwired and interconnected. At 10:18am smoke/carbon monoxide detectors were tested and observed to function properly. The fire extinguishers are located in the kitchen and the hallway, both purchased on 01/28/2025. Kitchen: The kitchen appliances and work surfaces are clean and sanitary, all appliances were observed to be functional. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. Knives were stored in a locked drawer in the kitchen. There is a dining set on one corner of the kitchen. Bedrooms: There were five (5) bedrooms designated for residents' use. All of the bedrooms, in use by residents were were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms had required functional fixtures, grab bars and non-kid mats. Hot water temperature was measured at 107.2 and 109.4 degrees Fahrenheit. Continue on 809-C Common Areas: These included the dining area in kitchen, living room and dining room. There is a non-functional fireplace in the living room, behind a sofa, inaccessible to residents in care. In the living room, there are games, television, cable and internet access for clients' use. The common areas were properly furnished with ample seating for all residents and staff. Surrounding Grounds: There are no bodies of water present. There are exit doors in each bedroom, and in the hallway, leading to the backyard. Facility uses the side gate as the main emergency exit. All walkways and exit passages were free of obstruction. There is a covered patio with two sets of furniture, appropriate for outdoor use. There is a detached garage, currently used as storage. LPA observed a freezer and refrigerator, stocked with clearly marked perishable food supplies in the garage. There are locked cabinets for storage of chemicals and detergents in the garage. Attached to the garage, there is a room, only used as storage and is kept locked, inaccessible to residents.. Laundry Room: Washer and dryer are located in the laundry room, next to bedroom #5. Chemicals and detergents are locked in the laundry room, inaccessible to residents. Medications: Medication and Medication Records are kept locked in a hallway closet. Medications for 3 out of 6 residents were counted and records were reviewed for accuracy of administration. Resident Files: LPA conducted a file review of all 6 resident records to ensure compliance of licensing forms and current physician records. Staff Files: LPA conducted a file review of staff records to ensure forms and training are up to date and compliant with licensing forms. Operational Requirement: Liability Insurance was reviewed with expiration date of 10/26/2026, in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. Surety Bond was reviewed with expiration date of 11/12/2026, approved in the amount of $10,000.00. Administrator Certificate expiration date is 08/10/2027. Facility conducts quarterly emergency drills; the last fire drill was conducted on 08/01/2025 and earthquake drill was conducted on 07/01/2025. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Sep 26, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto Lopez conducted the required annual inspection. LPA arrived unannounced and DSP Gaynane Petrosian who allow entry and Mikayel Gurokyan, house manager arrived short time later and LPA explained the purpose of the visit. The facility is licensed for residents ages 60 and over, may retain a maximum of six (6) hospice residents, and six (6) bedridden. Currently facility has 0 hospice residents. The home is for Developmentally Disabled, Level 4D. Currently there is one resident over 60 years of age and 4 residents under 60 years of age. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 3. Physical Plant and Environmental Safety: The facility is a single-story house and located in a residential neighborhood area. The facility includes Dining area, kitchen, sitting room, five (5) residents bedrooms, two (2) resident bathrooms, laundry room, detached garage. Each resident bedroom has one bed, dresser, required beddings and furniture and sufficient lighting and closet space. The two residents bathrooms are clean, sanitary and in a good working condition. Both bathrooms have the required grab bar and non-skid mat. The two bathrooms hot water temperature were tested between 107.0 and 111.0 degrees F. which is within the Tittle 22 regulation. All the appliances in the kitchen and living room are working well. The sharp knives are stored in a locked kitchen drawer. (Continue on 809C) (continue from 809) All the cleaning supplies and chemicals are stored and locked in a cabinet in the laundry room area The linen and towels are stored in the hallway cabinet. The extra personal hygiene products are stored in the locked cabinet in the hallway. The carbon monoxide detectors were inspected, and they are working properly. The facility has table and chairs for resident to utilize outdoor activity. The Passageway, walkway and patio are free of obstruction. 4. Staffing: The facility has sufficient staffing, and the night supervision staff have current CPR/first aid certification. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. All the direct care staff have ongoing Medication Management and other required Training. 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster and Residents personal rights are posted by the main entry. Visiting hours are included in admission agreement. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be very clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept very clean and free from rodents. 10. Incidental Medical and Dental: The medication is centrally stored and locked in the medication cabinet in the hallway. Five (5) centrally stored resident medications were reviewed, which contained 30-day supply of medications. Facility will provide transportation to resident for medical and dental appointment if needed. 11. Disaster Preparedness: The last fire drill was conducted on 10/02/24.. The facility has an Emergency Disaster Plan (LIC610E) dated on 10/01/24 that needs to be updated. The facility has two alternative temporary shelter location. 12. Resident with Special Health Needs: No residents are receiving home health services. No resident is currently on postural support. Individual Service Plans and Appraisals are on file. No deficiency observed during today’s visit. Technical Advisory provided. An exit interview was held. A copy of this report, and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 12, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced Annual Required visit to this facility. LPA met with Administrator, Michael Petrosian and explained the reason for the visit. At 4:45p.m. LPA and Administrator tour of the physical plant for compliance with safety, maintenance, and operational requirements. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Facility is a single-story house in a residential neighborhood and consisting of a common area, five (5) bedrooms, one (2) full bathroom and currently occupying six (6) residents. There is one entrance being utilized at the facility, there are required posters at the main door. Smoke detectors are hard wired and interconnected. Smoke detectors and Carbon Monoxide detectors were tested and function properly. Facility disaster drills was conducted on 11/01/2023. The facility maintains a comfortable temperature at 70°F. There are two (2) charged fire extinguisher in the facility. Fire extinguishers are in the kitchen and by the door leading to the backyard. Fire extinguishers are fully charged and receipt of purchase on 01/23/2023 and 04/08/2023. Cleaning supplies and toxic substances are inaccessible to residents. Hot water temperature was tested in bathrooms and in the kitchen. The hot water temperatures measured between 113.3 - 116.5 degrees Fahrenheit (F) which are within the required range for residents comfort and safety. Exit doors have auditory devices that were operating at the time of the visit. Kitchen: The kitchen appeared clean and fixtures functional. Kitchen knives and other sharp items are stored in a lock drawer in the kitchen. The supply of dishes and eating utensils was more than adequate. Laundry Room: Equipped with washer and dryer. Laundry supplies are kept locked. Located at the ended of the hallway. Continued from 809) Hallway: Personal hygiene, household cleaning and supplies are kept locked in a cabinet. Resident medication, resident and staff records are kept locked on the other cabinet. Bedrooms: The residents’ bedrooms were properly furnished and had adequate lighting and closet space. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and had functional fixtures. LPA observed grab bars in both bathrooms. The bathroom had non-skid mat in shower. Residents have enough personal hygiene supplies. Common Areas: The living room has a television, a massage chair, three (3) couch, two (2) recliner chairs and a functional telephone. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and in good repair. At 5:15p.m. LPA observed residents resting in their bedroom. Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use in the back of the garage. There are no bodies of water and firearms on the premises. Garage: Detached located in the rear of the facility, which stores personal protected equipment (PPE), emergency food, maintenance supplies, resident diapers, two (2) operation refrigerators with extra Non-perishable and perishable food. Next to the garage there is a storage room. In addition to the physical plant LPA conducted a file review for all residents and staff regularly scheduled. Staff have current first aid and training documentation showing required training completed. Resident records observed to be complete at this time. Per California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, deficiencies were not observed/cited. Exit interview conducted and copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Nov 27, 2023