Angels Hands Senior Living

Type of visit: Required - 1 Year

At 09:55 a.m. Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Marine Ghukasyan was contacted telephonically and the reason for the visit was explained. The Administrator arrived shortly thereafter. At 10:20 a.m. the LPA conducted a tour of the physical plant with the Administrator to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: The home is a single story family home consisting of a living room, dining room, family room, kitchen, 3 resident bedrooms, one office/staff room, 2 full bathrooms and a attached garage. The LPA observed fire extinguishers at the home, which were fully charged and last serviced 09/19/2024. All smoke alarms and carbon monoxide detectors were tested, and functioned properly. The LPA observed all required postings in the living room of the home. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked drawer on the left side of the stove and cleaning supplies are stored in a in a locked cabinet under the sink. At 10:23 a.m. the LPA observed two food cabinets with locks, during the visit the locks were unlocked, however when questioned staff stated that they are locked at night due to a resident removing the food at night. Locks were removed during the visit. Report will continue on LIC809-C, 2nd page. Bedrooms: All resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident. At 10:32 a.m. the LPA observed a door lock latch in room #2 on the door leading outside near the top. The LPA could not unlock it without the assistance of staff. Door lock was removed during the visit. Bathrooms: The LPA observed all bathrooms, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in all bathrooms. At 10:47 a.m. water temperature in resident’s restroom was measured at 112.5 degrees Fahrenheit. Common Areas: These included the living room, family room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. There is a fireplace in between the living room and family room, which is covered with a screen. There were no obstructions and/or tripping hazards throughout the inside of the facility. At 11:30 a.m. the LPA observed a door lock latch on the front door. Lock was removed during the visit. The garage: The LPA observed the garage where additional supplies and the emergency water is stored. Cleaning supplies and disinfectants are kept in the garage. The garage is locked. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water on the premises. At 10:59 a.m. the LPA observed the outdoor wooden walkway outside of room #2 with multiple boards uneven with visible gaps between them, some boards appear loose, and a few sections look sunken. Record Review: At 12:07 p.m. a review of facility files was initiated. The LPA reviewed five (5) out of five (5) resident files. The LPA observed documentation of Infection Control, Disaster prevention and last Disaster drill (conducted on 03/14/2026). The LPA advised to conduct disaster drills for every shift. The LPA obtained Client Roster, Staff Roster, and Insurance Liability. The LPA reviewed five (5) out of five resident files and four (4) out of four staff files. All documents reviewed appeared complete and current. Interviews: The LPA conducted three (3) resident Interviews. No immediate concerns were voiced. Report will continue in LIC809-C, 3rd page. Medications: At 3:00 p.m. a medications review was initiated for two out of five residents and the following was observed. The medications were stored in a locked cabinet in the kitchen and inaccessible to the residents. During Resident #1 (R#1's) audit, the following was observed: Loratadine 10 mg not documented on the Facility Centrally Stored Medication and Destruction Record (CSMDR), Insulin's instructions documented wrong, 2 units documented when its 16units, Lantus instructions documented wrong -16 units documented when its 15, and Pravastin's strength and quantity was not documented. During Resident #2 (R#2's) audit, the following was observed: Novolog was documented as Humolog according to the Administrator and documented as started but has not started medication and is still currently using Humolog. New order of Lantus was documented as started but not started and resident is still on the old order. Lorazepam medication filled in March is present but not being given or documented on the CSMDR, according to the Administrator it was discontinued but does not have a discontinued order and has not destroyed/discard the medication. At 3:58 p.m. the LPA observed Insulin pen with a needle, and observed staff dispense of the insulin pen needle in the kitchen trash can. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to Administrator.the state’s words, verbatim · CDSS document, May 13, 2026

The state marks this report as 12 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Allegation investigated: . Staff not allowing resident to leave facility for outings. 2. Facility does not have a phone accessible to residents. 3. Staff unable to meet residents needs due to language barrier. 4. Resident does not have a signed admission agreement

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced initial complaint visit to investigate the above allegations and was let into the home by Armine Safaryan, Staff. Gevorg Gevshenyan, Staff/Spouse of the Administrator, Marine Ghukasyan was contacted and they both arrived at the facility to conduct the visit. The reason for today's visit was provided. On today's visit, LPA Yee conducted a joint interview with Marine Ghukasyan,Administrator and Gevorg Gevshenyan, Staff/Spouse at 12:27pm, Resident #1 at 11:09am, Witness #1 at 11:57am and Resident #2 - Resident #5 begining at 4:14pm. Resident #1's file was reviewed at 12:20pm and copies were obtained. Per interviews conducted regarding allegation #1 - Staff not allowing resident to leave facility for outings,the information obtained reveal that Friend #1, who had just found the whereabouts of Resident #1 Unsubstantiated Page 2. came to visit. During the visit, Friend #2 also arrived to visit. According to the information provided, Friend #2 greeted Friend #1. Friend #1 responded to the greeting with "in heat like a dog" meanly referring to some incident that had happened years ago and walked outside. Friend #2 followed and wanted to have a conversation with Friend #1 but was not successful. Resident #1, Friend #1 and Friend #2 meet for dances and have known each other for a long while. Per information provided, Friend #1 has a history of drinking in excess, beginning in the morning and doing weed. On the day Friend #1 was visiting at the facility, they were observed to be inebriated and under the influence of something and was overreacting like they do when they have been drinking. Friend #1 went back into the facility to say good-bye to Resident #1 and get the resident's cell phone to take it to get it fixed and left. The phone had been disconnected due to non-payment. Friend #1 would return once the phone was fixed. When Friend #1 returned a few hours later, the phone had not been fixed. Friend #1 asked Gevorg, Staff/Spouse if they could take Resident #1 to get the phone fixed and he responded "no", due to Friend #1's earlier observed condition, reaction and why the phone had not been fixed. Friend #1 then asked Gevorg/Staff if Resident #1 could be taken for a walk and he said okay. Friend #1 and Resident #1 went for a 20-30 minute walk in the neighborhood. Per Gevorg/Staff, he did not want Resident #1 to get into any vehicle driven by Friend #1. After the walk, Friend #1 asked again if they could take Resident #1 to get the phone fixed the following day. Again the response was "no" due to concerns with Friend #1 being inebriated the following day. Per interviews conducted with Resident #1, Witness #1 and Staff, Friend #1 was definitely inebriated and under some kind of influence during the visit. Based on the information obtained, the facility staff does not disallow residents from leaving the facility, they just did not want Resident #1 to be driven around by an inebriated person or anyone under the influence, therefore there is insufficient evidence to support the allegation that Staff is not allowing resident to leave facility for outings and is unsubstantiated at this time. Per interviews conducted with Resident #1 and other residents regarding allegation #2, Facility does not have a phone accessible to residents, During the interview, Resident #1 immediately responded that the facility has a phone and it is located in the kitchen. Per interviews conducted, the residents have to ask staff for the telephone and it will be given to them. Two residents have a working cell phone and was not sure of the location of the phone since they do not use it. Resident #1 has a cell phone that is not connected due to non-payment and has been using the facility phone to make and receive call. Based on the information Page 3 received, there is insufficient evidence to support the allegation that the facility does not have a phone accessible to the residents, therefore the allegation is deemed to be unsubstantiated at this time. Per interviews conducted with the residents and LPA's conversation with Staff #1 regarding allegation that staff is unable to meet residents needs due to language barrier, reveal that Staff #1 speaks sufficient English to communicate with the residents and provide the basic services. Staff #1 however has a little more difficulty when it comes to more complicated words and uses a Google translator to assist in the communication. Per interviews with the Administrator and Gevorg, they are present at the facility all the time and are available if there are any emergencies or staff can call them on the phone. Residents all indicate that they are able to communicate with the staff sufficiently in English to get want they want. Based on the information received, there is insufficient evidence to support the allegation that staff is unable to meet the residents needs due to language barrier, therefore the allegation is unsubstantiated at this time. Regarding allegation #4 - Resident does not have a signed Admission Agreement, LPA Yee reviewed Resident #1's file and a copy of the Admission Agreement signed on 2/12/25 was observed in their file. Per information obtained during the visit, Resident says things and does things and does not remember. Per review of Resident #1's Physician's Report, the resident may have mild cognitive impairment or onset of dementia. Both boxes were checked off on the Physician's Report and the diagnosis is unclear. The facility was asked to contact the resident's physician to seek clarification and maintain in the resident's file. Based on the information obtained, there is insufficient evidence to support the allegation that Resident does not have a signed Admission Agreement, therefore the allegation is unsubstantiated at this time. Exit interview was conducted and a copy was providedthe state’s words, verbatim · CDSS document, Jun 11, 2025 · control 29-AS-20250609095732

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced visit to the facility for the purpose of delivering the report generated for the required Annual Inspection conducted on 5/16/25. Due to computer issues and the CARE Inspection Tool, LPA Yee was not able to leave a report or issue citations. LPA Yee was let into the home by Armine Safaryan, Staff. Marine Ghukasyan, Administrator, was contacted by staff via telephone and she arrived at the facility in a few minutes to conduct the visit. The report generated on 5/16/25 was signed by the Administrator on today's visit. Exit interview was conducted and a copy of the LIC809 report generated on 5/16/25 was provided.the state’s words, verbatim · CDSS document, May 28, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced required Annual Inspection visit and used the CARE Inspection Tool. LPA Yee met with Marine Ghukasyan, Administrator. The reason for today's visit was provided. The home is a single storey family home consisting of a living room, dining room, family room, kitchen, 4 bedrooms of which one will be used for live-in staff and as an office, 2 full bathrooms and a attached garage. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #2 is the room designated for bedridden use. On today's visit, LPA Yee reviewed 3 resident files and 4 staff files, reviewed medications and Medication Administration Record for Resident #3 and attempted to complete the infection control domain but was able to answer 32 questions only. The following were observed on today's visit: All three residents are receiving PRN medications but there are no completed PRN Authorization Letters on file to determine if the residents are able or unable to request their medications if needed or if staff should be contacting the physician for instructions prior to administrating the medications based on the residents' symptoms. During this visit, LPA Yee observed the Administrator dispense a pain pill to Resident #3 and it was refused by the resident. No contact was made with the physician. MAR logs are not being documented correctly. The daily MAR log is checked off when medications are dispensed and the staff dispensing the medication is unknown. The facility also keeps a separate MAR log for PRNs and cycle medications are included with a different time and looks like duplication of medications. Medication training was provided by the Administrator but documentation was unavailable. On 3/20/25 medication training was provided to 2 caregivers - Gevorg Gevshenyan and Armine Safaryan but medications dispensed are not being correctly documented as of today's visit. Resident #2 does not have a physical with evidence of a TB test Resident #3 does not have a completed Admissions Agreement on file. The facility does not have documentation of any of the emergency fire drills that have been conducted in 2024 and has only conducted one fire drill on 1/16/25. LPA Yee terminated the visit as the Administrator was not able to provide answers to the questions on the CARE Inspection Tool. Any deficiencies not addressed on today's visit will be addressed on a return visit. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted, Appeals Rights discussed and a copy was given.the state’s words, verbatim · CDSS document, May 16, 2025

Allegation investigated: Staff are keeping resident at the facility against their will.

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and was let into the home by Armine Safaryan, Staff. Staff contacted Marine Ghukasyan, Administrator, via telephone and she arrived at 1:59pm. The reason for today's visit was provided. LPA Yee conducted an interview with the Administrator at 2:05PM, Witness #1 at 2:36pm, Resident #1 at 3:01pm, Reporting Party at 3:32pm and Witness #2 at 4:22pm. LPA Yee also reviewed Resident #1's file and obtained copies throughout the visit. Per information received from interviews conducted, Resident #1 was residing at an unlicensed home located on Cedros Avenue and was taken to the hospital for treatment of an infection and hip pain. Prior to Resident #1 being discharged, the Department had already informed Witness #2 that Resident #1 could not be returned to the unlicensed home. Witness #2 had to locate licensed facilities in the vicinity of the Unsubstantiated hospital for new placement for Resident #1. This licensed facility was located and Resident #1 was transported to the home after a discussion was had between Witness #2 and the Administrator. After a couple of days, the Reporting Party contacted the hospital and the facility to advise them that they had stolen the resident from another licensed home. Per information provided by Witness #2, transportation records clearly show that Resident #1 was transported to the hospital from the unlicensed Cedros Avenue location and not from the licensed home that the Reporting Party claimed that Resident #1 was living at prior to hospitalization. Since the placement at this home, Reporting Party has indicated that Resident #1 does not have the mental capacity to decide where they want to live. Reporting Party alleges that Resident #1 is disoriented and confused. Per the Reporting Party, the Licensee informed them that if they want Resident #1, they should come get the resident and pay the licensee. Per interview conducted with Resident #1, the resident was observed to be well oriented, coherent and was having a normal conversation with Witness #1 during their visit in the resident's room. Per Resident #1, they do not want to move from this home. Per Resident #1, if they didn't like it at the home, they would grab their jacket and walk out. They love the food, especially the soup and they get fresh fruits even though Resident #1 eats very little. Witness #1 confirms that Resident #1 loves the home and has not seen the resident so happy in a long time. Per review of Resident #1's Physician's Report obtained from the hospital on 2/12/25, there is no indication that Resident #1 lacks the mental capacity to make decisions. It is noted that Resident #1 is occasionally forgetful. Based on today's investigation, there is insufficient evidence to support the allegation that Staff are keeping resident at the facility against their will, therefore the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 25, 2025 · control 29-AS-20250222205150

Type of visit: Case Management - Deficiencies

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced case management visit due to a deficiency noted during a visit to the facility today. The reason for the visit was explained. Per review of facility files, criminal record clearance documents were observed in the below staffs' files. However, neither staff noted below are associated to the facility. Gervog Gevshenyan, Staff is not associated to the facility Armine Safaryan, Staff is not associated to the facility Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. CIVIL PENALTIES were assessed. Exit interview was conducted, APPEALS RIGHTS were discussed and a copy was giventhe state’s words, verbatim · CDSS document, Feb 25, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 26, 2025

Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement was not met as evidenced by: Staff Armine Safaryan and Gervog Gevshenyan are not associated to the home. $1000 CIVIL PENALTIES WERE ASSESSED.the state’s words, verbatim · CDSS document, Feb 25, 2025

Plan of correction: Licensee will ensure that all staff, volunteers or individuals who require to be associated to the facility are associated prior to being present at the facility. LIcensee will associate the 2 staff to the facility via Guardian or submit a completed LIC9182 with a legible copy of their driver license to the Regional office by 2/26/25.

Type of visit: POC

Licensing Program Analyst(LPA), Christine Yee, conducted a subsequent announced case management visit to verify that the deficiencies observed during the initial Prelicensing and Component III visit conducted on 3/21/24 was corrected. LPA Yee met with Marine Ghukasyan, Applicant. Also present during the visit was Gevorg George Gevshenyan, family member. Per today's visit, the following corrections were observed: the water temperature was tested in the common bathroom and it read 119.6 degrees Fahrenheit the water temperature was tested in the private bathroom and it read 119.5 degrees Fahrenheit. a blanket and a flat sheet was observed on each resident bed and 2 extra blankets were observed stored in the residents closet in each room a grab bar was observed in the shower stall located in the private bathroom the Long Term Care Ombudsman poster was obtained and was observed posted by the front door the complaint poster that met Title 22 size requirements of 20" X 26" was observed posted on the living room wall by the front door.* the water stain on the living room ceiling was painted. the double sided fire place between the living room and family room was observed with a fire screen on each side. the sliding screen door of the family room was observed to be repaired. a window screen was observed on the window located in bedroom #1. The following must be completed once the facility is licensed: liability insurance that meets Title 22 requirements will be purchased. perishable foods for a minimum of 2 days will be purchased prior to the acceptance of the first resident. Exit interview was conducted.the state’s words, verbatim · CDSS document, Apr 4, 2024

Type of visit: Prelicensing

Licensing Program Analyst(LPA) Christine Yee conducted an announced Prelicensing and Component III visit to inspect the physical plant to ensure that the home met Title 22 requirements. The complete CARE Inspection Tool was utilized. LPA Yee met with Marine Ghukasyan, Applicant. Also present during the inspection was Gevorg George Gevshenyan, family member. The home is a single storey family home consisting of a living room, dining room, family room, kitchen, 4 bedrooms of which one will be used for live-in staff and as an office, 2 full bathrooms and a attached garage. The facility is fire cleared for 5 NON-AMBULATORY and 1 BEDRIDDEN residents. Bedroom #2 is the room designated for bedridden use. The following was observed on today's visit: The living room was observed with a piano, a bench and a coffee table. Fire place was capped off but does not have a fire screen. The dining room was observed with a large table and 8 chairs. The family room was furnished with a leather sofa, love seat, arm chair, foot stool, a little armchair, coffee table and television. The fireplace did not have a fire screen. The sliding glass door was equipped with an operable auditory device. The top of screen door was observed to be separated from the frame and needs to be fixed The kitchen is equipped with a stove, dishwasher, coffee machine and microwave. There was sufficient non-perishable foods observed for a minimum of 7 days. No perishable foods were purchased on today's visit. The Applicant was advised that perishable foods for a minimum of 2 days must be purchased prior to the acceptance of the first resident. The following was observed: 20 dinner plates, 12 bowls, 8 cups, 6 tall glasses, 6 short glass, 7 salad plates, 8 saucers, 3 serving bowls, 12 forks, 12 knives, 12 tablespoons and 12 teaspoons were observed. Also observed were sufficient pots and pans. The staff room/office located behind the kitchen was equipped with a full size bed, dresser, desk, little refrigerator for the storage of medications. The first aid cabinet and first aid manual was stored in the room. The auditory device on the outside exit door was tested and was operational. Bedroom #1, located to the left of the facility was furnished with 2 beds, 2 night stands, 2 lamps, 2 chairs, one shared dresser and a closet. The following was observed on the 2 beds were, a mattress cover, a fitted sheet and a comforter. No blankets or flat sheets or window screens were observed. Window has blinds The common bathroom contained a walk in shower, toilet and a sink. A grab bar and non-skid mat was observed. Water temperature was tested and it initially read 122.50 and re-tested at 2:56pm and it read 127.3 degrees Fahrenheit. Bedroom #2, designated as the bedridden room for 1 was furnished with 2 beds, 2 chairs, 2 night stands, 1 shared dresser, 2 lamps and a closet. Beds had a mattress cover, fitted sheet and a comforter. No blanket or flat sheet was observed. The auditory device on the outside exiting door was tested and was operational. Located outside the door was a ramp. Bedroom #3 was furnished with 2 beds, 2 night stands, 2 lamps, 1 shared dresser, 2 chairs and a closet. The beds were observed with a mattress cover, fitted sheet and a comforter. 1 blanket was observed in the closet. Located inside the room is a private bathroom equipped with a tub, a shower stall, a toilet and a vanity with a sink. Grab bars and non-skid mat was observed in the tub and by the toilet. The shower was missing a grab bar. The water temperature was tested and initially read 125 degrees Fahrenheit at 1:49pm and was re-tested at 3:01pm and it read 125.2 degrees Fahrenheit. The following linens were observed in the cupboard located by the front door: 12 bath towels, 16 face towels and hand towels, 18 flat sheets, 18 fitted sheets and 18 pillow cases. No additional blankets were observed. All the windows have blinds for privacy The facility has 2 fire extinguishers purchase on 2/3/24. One is located in the kitchen and the other by the front door. The two carbon monoxide detectors are located in the hallway of the resident bedrooms. One of the carbon monoxide detector is hard wired with the smoke detectors. The smoke detectors were tested and were operational. The facility also has a pull alarm system located by the front door with alarms located by the common bathroom and inside bedroom #3. Per tour of the enclosed backyard, an umbrella with 6 chairs were observed for resident use. Backyard and front yared was observed to be clean. The 2 trash cans stored in the front yard y were observed to be tightly sealed and the other three were on the street due to trash pick up. The following corrections need to be made prior to licensure: The thermostat on the water heater needs to be adjusted so that the water temperature is within 105 -120 degrees Fahrenheit blankets need to be purchased and made available for resident use. a grab bar needs to be installed in the shower stall located in the private bathroom a Long Term Care Ombudsman poster needs to obtained and posted the complaint poster that meets Title 22 size requirements of 20" x 26" the water stain on the living room ceiling needs to be painted. the fire place needs to made inaccessible to the residents. A fire screen will meet this requirement. the sliding screen door of the family room needs to be repaired. a window screen needs to be placed on the window located in bedroom #1 The following must be completed once the facility is licensed: liability insurance that meets Title 22 requirements will be purchased perishable foods for a minimum of 2 days will be purchased prior to the acceptance of the first resident. Once all the corrections have been completed, the Applicant will notify LPA Yee so that a return visit may be conducted to clear the facility. COMPONENT III was conducted Marine Ghukasyan and Gevorg Gevshenyan. Exit interview was conducted.the state’s words, verbatim · CDSS document, Mar 21, 2024