Ano Two Facility for the Elderly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA met with the Administrators Nektar Chamchyan, and Artur Atoyan and explained the reason for the visit. The LPA, along with the Administrator 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. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 07/03/2026. Exits have functioning auditory devices. The fire alarm/ carbon monoxide detectors were tested and functioned properly. The LPA observed cameras in the common areas, and throughout the exterior perimeter of the facility. Night lights were present in the hallways and passages. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Hot water measured at 115.3-degree Fahrenheit. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside a kitchen cabinet. Medications are located in a locked cabinet next to the refrigerator. Continued on LIC 809-C… BEDROOMS: The facility is a single-story facility with three (3) bedrooms for resident use and one (1) office. There are two (2) bathrooms, one (1) bathroom is used for staff only and the other one is for residents' use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Hot water measured at 116.1-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: The LPA observed the front patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. Passageways were free and clear from obstruction. The facility has an Additional Dwelling Unit (ADU) at the back of the facility and is not part of the license. The ADU remains inaccessible to residents. Laundry units are located in a laundry room area, where two washers and two dryers were observed. The laundry room is kept locked with a key. 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 annual training. All files were in order. MEDICATIONS: Medications are located in a locked cabinet next to the refrigerator.; 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 No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 18, 2026

Allegation investigated: Resident developed multiple pressure injures due to neglect by staff. Staff did not seek timely medical attention for resident in care.

On 06/26/2026, 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 contacted the Administrator on the phone. The LPA spoke with the Administrator and explained the reason for the visit. The Administrator stated they were out shopping and agreed to have the LPA read the report over the phone and have facility representative sign the report. On 07/31/2025, the Community Care Licensing Division (CCLD) received a complaint about the allegations listed above. On 07/31/2025, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced visit to investigate the allegations. LPA Urena conducted an initial investigation and interviewed the Administrator, staff and R1 from approximately 1:42 p.m. to 2:55 p.m., and requested records pertinent to the investigation. Continues on LIC9099C 2... Unsubstantiated Pg 2. Resident developed multiple pressure injuries due to neglect by staff. On the allegation that Resident #1 (R1) developed multiple pressure injuries while in care due to negligent staff, it is the concern of the Reporting Party (RP) that R1 was observed to have various pressure injuries: Stage 3 and Stage 4 pressure injuries located in the areas of the left ankle, middle of the foot, and various stage pressure wounds of the left elbow, in-between the second and third toe of the right foot and the coccyx area due to staff neglect. To investigate the allegation, LPA Urena conducted interviews and record review. The LPA interviewed the Administrator about the pressure wounds, and the Administrator reported that R1 was admitted to the facility on 10/01/2024 with wound care and was receiving wound care from a Skill Nursing Facility (SNF) prior to admission and has continued to receive wound care from the Hospice and Home Health providers through the resident’s health provider, Kaiser Permanente. Staff’s interview revealed that they assisted R1 with repositioning throughout the day, keeping them clean and dry, and following Home Health nurse instructions. LPA Urena interviewed R1, and R1’s interview revealed that R1 is alert and oriented; R1 was able to understand and answer the LPA’s questions. R1 reported to be receiving very good care from staff. Staff assist with repositioning, incontinent care and transfer from bed to wheelchair, and staff take R1 to the backyard for fresh air as weather permits. Furthermore, R1 reported having a nurse who attends to their skin issues. LPA Urena interviewed the responsible party for R1, and the responsible party reported that R1 had developed pressure wounds before being admitted to the facility on 10/01/2024, however, the responsible party could not provide the stage of the pressure wounds, or location of the wounds. Furthermore, the responsible party reported that R1 has been receiving continuous wound care at the facility at least two times per week and has received wound assessments several times. Responsible party added that R1 was receiving good care at the facility and was informed anytime that R1 had a change in condition. Residents’ interviews revealed that staff take care of their needs and are responsive when the residents have a change in condition. LPA Urena conducted record review of documents pertaining to the investigation: Record review of Radiant Hospice Care Inc. (RHC) indicates that R1’s Effective Date of Certification was 09/21/2024 to 11/19/2024. Effective Date of Service was 10/03/2024. Certification was based on face-to-face encounter conducted on 07/23/2024. Plan of Care indicates that RHC was providing care to R1 for Hypertensive heart disease with heart failure, resident is non-ambulatory and spends most of their time laying down due to generalized body weakness. Continues on LIC 9099C3... Pg.3 Record review indicates that on 10/25/2024, R1 was admitted to the Kaiser Permanente Skilled Nursing Facility (SNF) Grand Valley Health Care and was discharged back to facility on 11/03/2024. Discharge instructions from SNF indicated that R1 would be evaluated through Home Health Nursing for medication compliance, diabetic education, and wound care. Skin & Body Assessment graph indicates chronic ulcer of the left ankle, and sacrum redness. Record review of three (3) Wound Healing Care Specialists Agency-Progress Notes dated 05/19/2025, 05/26/2025 and 06/02/2025, indicated that R1 received wound care for left plantar foot (Arterial Ulcer with unspecified severity); and left great toe (Arterial Ulcer with unspecified severity). Treatment Start Date: 04/15/2025. Assessment-Chronic comorbid conditions: Healing is delayed due to advanced age, fragile skin, immobility or limited mobility, medical comorbidities, paralysis, and integumentary failure. Staff were instructed on pressure reliving measures, such as repositioning every two hours, use of float heels, to pad bony areas, and to keep skin clean and dry. Record review of Physician’s Report dated 06/02/2025, indicated that R1 had a history of skin breakdown, and was receiving hospice services for terminal illness (heart disease). Record review of CALWOUND-Wound Assessments dated 05/02/2025; 05/09/2025; 05/16/2025; 06/20/2025; and 07/18/2025. Wound assessment indicated that R1 was assessed for five wounds-Wound #1: Right foot/medial as resolved. Wound #2: Left foot lateral,-non-pressure, full thickness, with bony prominence. Wound #3: Left lateral ankle, as resolved. Wound #4: Left elbow as resolved. Wound #5: Left foot medial aspect, non-pressure, full thickness, necrotic, erythema, with bony prominence. Frequency of Dressing changes: three times per week. Nursing to continue planned visits two times per week for wound care. Record review of Mobile Rapid Recovery -Visit Reports dated 06/04/2025, an initial wound care evaluation was done. On 06/11/2025, and 06/18/2025, indicated that R1 presented with two wounds: Left lateral foot is a chronic diabetic ulcer and received status of Not Healed, and Left medial foot is a chronic diabetic ulcer and received status of Not Healed. On 06/11/2025, Follow up wound care: both wounds have decreased in size. Wound provider to continue care once a week. Barriers to healing: Diabetes and impaired mobility, decreased appetite/poor nutrition intake. Visit Report dated 06/18/2025, indicated that caregivers were expected to apply Sanytl Ointment (prescription medication) to the pressure wounds and do wound dressing daily. (Administrators and caregivers denied doing this type of wound care.) Continues on LIC 9099C4... Pg.4 Record review of three Progress Notes for Wound Wagon -Mobile Wound Care, dated 06/29/2025, 07/06/2025, and 07/19/2025 indicated the following: Records dated on 06/29/2025, indicated treatment for Diabetic Ulcers of the left great toe, foot; and left lateral foot, furthermore it indicated that “both wounds are healing well with no signs of infection”. Furthermore, records dated 07/06/2025, indicated that “week two of amniotic tissue XCell Matrix Amino-both wounds are healing well, with left lateral foot showing especially notable improvement in size and reduction, tissue quality, absence of infection.” Record review of Kaiser Permanente Records dated 07/25/2025 to 07/26/2025 indicated that R1 was admitted to the hospital for the following diagnosis: Gallstone pancreatis, urinary tract infection (UTI), acute kidney injury, incidental adnexal mass. R1 was discharged to facility with care instructions, and home health care services. Record review of CVH Care/Oasis dated 07/28/2025, indicated that R1 was assessed and found to have a Stage IV, left medial foot pressure wound, and a Stage III, left lateral foot pressure wound, and a Stage I, left elbow pressure wound. The information obtained through records review indicates that R1 had a history of skin breakdown, R1 was non-ambulatory and spent most of their time laying down due to generalized body weakness, and on 10/25/2024, R1 developed the first signs of pressure wounds. Furthermore, record review indicates that R1’s healing was delayed due to advanced age, fragile skin, immobility or limited mobility, medical comorbidities, paralysis, and integumentary failure, and poor nutrition intake. Records review indicate that staff received education on wound care on pressure reliving measures, such as repositioning every two hours, using float heels, padding bony areas, and keeping skin clean and dry. Interviews revealed that staff provided repositioning and pressure wound preventive care, and that facility staff followed the care plan. Therefore, the allegation that the resident developed multiple pressure injuries due to neglect by staff is deemed Unsubstantiated at this time. Continues 0n LIC 9099C5... Pg. 5 Staff did not seek timely medical attention for resident in care. It is alleged that the facility staff did not seek timely medical attention for R1, for a stage 4 pressure injury, which appeared to have started as a deep tissue injury, and which had deteriorated with purple/red moist base and palpable bone. LPA Urena conducted record review and conducted interviews to investigate the allegation. The record review indicated that the resident was receiving on-going wound care from home health, and hospice agencies. Furthermore, record review indicated that every time the resident had a change in condition, staff would seek timely care for the resident by informing the resident’s responsible party and getting appropriate medical care for the resident. Interview with the resident’s responsible party indicated that the facility is in contact with them often, and facility staff reports changes in resident’s condition. Based on the information obtained through record review and interviews, the allegation that staff did not seek timely medical attention for the resident in care, is deemed Unsubstantiated at this time. Exit interview was conducted. A copy of the report and appeal rights was issued.the state’s words, verbatim · CDSS document, Jun 26, 2026 · control 29-AS-20250731084950

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA met with the Administrators Nektar Chamchyan, and Artur Atoyan and explained the reason for the visit. The LPA, along with the Administrator 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. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 07/17/2025. Exits have functioning auditory devices. The fire alarm/ carbon monoxide detectors were tested and functioned properly. The LPA observed cameras in the common areas, and throughout the exterior perimeter of the facility. Night lights were present in the hallways and passages. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Hot water measured at 110.5-degree Fahrenheit. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside a kitchen cabinet. Medications are located in a locked cabinet next to the refrigerator. Continued on LIC 809-C… BEDROOMS: The facility is a single-story facility with three (3) bedrooms for resident use and one (1) office. There are two (2) bathrooms, one (1) bathroom is used for staff only and the other one is for residents' use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Hot water measured at 106.1-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: The LPA observed the front patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. Passageways were free and clear from obstruction. The facility has an Additional Dwelling Unit (ADU) at the back of the facility and is not part of the license. The ADU remains inaccessible to residents. Laundry units are located in a laundry room area, where two washers and two dryers were observed. The laundry room is kept locked with a key. RECORDS: Records review began at 10:45 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 annual training. All files were in order. MEDICATIONS: Medications review began at 1:15 p.m.; Medications are located in a locked cabinet next to the refrigerator.; 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 No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA met with the Administrators Nektar Chamchyan, and Artur Atoyan and explained the reason for the visit. At the time of the annual inspection, the facility has one resident. However, the resident is currently at a Skilled Nursing Facility (SNF) receiving physical therapy and is expected to be back in a couple of weeks, depending on the progress done at the SNF. The LPA, along with the Administrator 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. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 07/02/2024. Exits have functioning auditory devices. The fire alarm/ carbon monoxide detectors were tested and functioned properly. The LPA observed cameras in the common areas, and throughout the exterior perimeter of the facility. Night lights were present in the hallways and passages. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Hot water measured at 110.5-degree Fahrenheit. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside a kitchen cabinet. Medications are located in a locked cabinet next to the refrigerator. Continued on LIC 809-C… BEDROOMS: The facility is a single-story facility with three (3) bedrooms for resident use and one (1) office. There are two (2) bathrooms, one (1) bathroom is used for staff only and the other one is for residents' use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Hot water measured at 106.1-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: The LPA observed the front patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. Passageways were free and clear from obstruction. The facility has an accessory dwelling unit (ADU) at the back of the facility and is not part of the license. The ADU remains inaccessible to residents. Laundry units are located in a laundry room area, where two washers and two dryers were observed. The laundry room is kept locked with a key. RECORDS: Records review began at 12:45 p.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 annual training. All files were in order. MEDICATIONS: Medications review began at 1:15 p.m.; Medications are located in a locked cabinet next to the refrigerator.; 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 No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 20, 2024

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 08/23/2023. At 9:30 a.m., the LPA met with the Administrators and explained the reason for the visit. RECORD REVIEW: At 10:20 a.m., the LPA reviewed resident records for two (2) out of two (2) residents. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. All files were in order. At 11:15 a.m., the LPA conducted a personnel file review for all staff regularly scheduled and reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. At 2:48 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for two (2) residents and observed that all medications were properly documented. Copy of valid liability insurance and Facility Emergency Plan was provided to the LPA during the visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report of provided.the state’s words, verbatim · CDSS document, Sep 28, 2023