AV Assisted Living

Allegation investigated: Staff do not ensure the residents have adequate bedding. Staff do not ensure residents needs are being met.

On 8/06/2026 at approximately 9:50 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced initial complaint visit to the facility. LPA was greeted by staff and stated the reason for their visit. The Licensee, Arlen Shahverdian was not available to assist with today’s visit and designated one of the care staff to sign today’s report. To investigate the allegation(s), at approximately 10:00 AM, LPA conducted a physical plant tour. By 10:30 AM, LPA requested relevant documentation such as but not limited to: Physician’s Report and Pre-Appraisal. From 10:30 AM to 2:30 PM, LPA conducted interviews with four (4) residents (R1-R4), two (2) staff members (S1-S2), and conducted record review. (continue to LIC 9099-C) Unsubstantiated Regarding the allegation: Staff do not ensure the residents have adequate bedding. It was alleged residents were not being provided with adequate bedding. To investigate the allegation, LPA conducted interviews with four (4) residents and two (2) staff members. LPA’s interview with R1 revealed they do not have a mattress to sleep on. LPA’s interview with three (3) residents revealed that they have a mattress and staff help wash their sheets weekly and as needed. LPA’s interview with both staff members revealed that residents’ beds sheets are washed weekly or as needed such as if residents were to have an accident. During LPA’s physical plant tour, LPA observed R1’s bedroom to be equipped with a bed, mattress and sheets. LPA observed all residents’ rooms to be adequately furnished with appropriate bedding and sheets. LPA observed the laundry appliances to be in proper condition and working. LPA observed extra linens to be located in a storage closet. Additionally, LPA observed the facility to be equipped with sufficient cleaning equipment/supplies located in both the locked storage closet and storage unit. Based on interviews and observations, LPA observed all residents’ rooms to be properly furnished with bedding and bed sheets. Therefore, the allegation is UNSUBSTANTIATED at this time. Regarding the allegation: Staff do not ensure residents needs are being met. It was alleged that R1’s and the other residents were being neglected from receiving proper quality care. To investigate the allegation, LPA conducted interviews with four (4) residents. When questioned whether staff are assisting them with their needs; Activities of Daily Living (ADLs), all four (4) residents confirmed their needs are being met. LPA’s interview with R1 revealed staff assist them with their showering and toileting needs. R1 stated they can change their own clothing and feed themselves but want to live where medical services are provided like in hospitals. LPA disclosed to R1 that they are living in a non-medical care facility. R1 stated, “Oh I see, I was confused”. LPA’s record review of R1’s Pre-Appraisal confirmed R1 to need assistance with showers and can transfer themselves to and from bed. During LPA’s physical plant tour, LPA observed the facility to be neat, clean and organized. LPA observed sufficient supply of food. LPA observed residents, including R1, to be participating in exercise activities in the common area. Additionally, throughout the remainder of the visit, LPA observed residents to be eating in the dining hall and residing in their bedrooms watching television. Based on interviews, record review and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. (continue to LIC 9099-C) No immediate health and safety issues observed during the day of the visit. Exit interview was conducted (LPA provided the findings of the complaint to the Licensee), and a copy of this report was provided to the care staff.the state’s words, verbatim · CDSS document, Aug 6, 2026 · control 31-AS-20260730163647

Allegation investigated: Staff are not treating resident with dignity and respect. Staff does not ensure resident receives adequate portions of food.

On 6/18/2026 at approximately 1:10 PM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by staff and stated the reason for their visit was to deliver the findings of the complaint. The Licensee, Arlen Shahverdian was not available to assist with today’s visit and designated one of the care staff to sign today’s report. LPA provided the findings of the complaint to the Licensee. To investigate the allegation(s), on 6/06/2026 at approximately 02:00 PM, LPA conducted a physical plant tour. By 02:30 PM, LPA requested relevant documentation. From 02:00 PM to 04:00 PM, LPA conducted interviews with eight (8) residents (R1-R8), three (3) staff members (S1-S3), and conducted record review. (Continue LIC 9099-C) Unsubstantiated Regarding the allegation: Staff are not treating resident with dignity and respect. It was alleged that staff do not treat R1 with dignity and respect. To investigate the allegation, LPA conducted interviews with eight (8) residents and three (3) staff members. LPA’s interview with R1 revealed that are not disrespected by staff but instead they hear staff speaking in Spanish complaining about helping residents. LPA’s interview with seven (7) residents confirmed staff treat them with dignity and respect. LPA’s interview with all three (3) staff members confirmed residents are not mistreated. During LPA’s visit, LPA observed staff to be assisting residents with their Activities of Daily Living (ADLs) such as toileting, grooming and eating. LPA did not observe staff to be speaking to residents inappropriately. LPA did not observe staff to be disrespectful to residents. LPA observed staff to be speaking in Spanish (let it be noted LPA is fluent in Spanish) with one another and the residents who speak Spanish. LPA observed staff when speaking in Spanish were not speaking of any residents in a disrespectful manner. Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Regarding the allegation: Staff does not ensure resident receives adequate portions of food. It was alleged R1 does not receive adequate portions of food. To investigate the allegations, LPA conducted interviews with eight (8) residents and three (3) staff members. LPA’s interview with R1 revealed they witness staff giving other residents “bigger” portions of food than them. When LPA questioned, if they have any food restrictions/diet, R1 stated, “no”. when questioned if they were diabetic, R1 stated, "Yes”. LPA’s interview with seven (7) residents confirmed they are feed three (3) times a day and provided with snacks. LPA’s interview with all (3) staff members correlated with the seven (7) residents’ interviews. LPA’s interview with S3 revealed they have to monitor residents dietary restrictions for those who are diabetic or have food restrictions. During LPA’s physical plant tour, LPA observed the kitchen to be supplied with sufficient seven (7) day nonperishable food and two (2) day perishable foods. Additionally, LPA observed residents’ dietary/food restrictions to be posted in the kitchen such as Diabetes data/food log, Basic Carb Counting, and High Potassium Foods. (continue to LIC 9099-C) Furthermore, LPA observed S2 to be preparing food for residents. During LPA’s record review of R1’s physician’s report, the report confirmed R1’s diagnoses. LPA’s web search of said diagnosis revealed, “…portion control is key to managing blood sugar and weight”. Based on interviews, record review and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the care staff..the state’s words, verbatim · CDSS document, Jun 18, 2026 · control 31-AS-20260604153733

Type of visit: Prelicensing

On 2/23/2026, at approximately 09:45 AM, Licensing Program Analyst (LPA) Angelica Segovia and Policy Manager (Supervisor I) Carly Hansford conducted an announced Pre-licensing visit. LPA Segovia met with Administrator Ariga Mirzakhanian and Licensee, Arlen Shahverdian. An application was submitted to Community Care Licensing Division-CCLD on 11/18/2025, Initial license for a Residential Care Facility for the Elderly (RCFE), 60 years and older. The requested capacity is for twenty (20) non-ambulatory residents of which two (2) may be bedridden. The fire clearance was approved on 1/27/2026. A physical plant tour was conducted and the following was noted: Structure: The facility is a two-story building with ten (10) bedrooms and five (5) bathrooms. One (1) room, located on the second floor, is a designated staff room with its own bathroom. Entrance: There is one (1) main entrance/exit being utilized. Required postings such as: See/Say Something and Long-Term care Ombudsman were observed immediately upon entrance. Common Areas: These include both living room and dining room. All common areas were observed to be neat, clean and organized. All common areas were properly furnished and in good repair. The facility maintains a comfortable temperature of seventy-one (71) degrees. No firearms observed or will be maintained on the premises. Residents/staff files: The resident and staff files will be kept in locked staff room inaccessible to residents. LIC809C-continued Kitchen: Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods will be purchased prior to residents’ arrival. LPA observed sufficient supplies of dishes, cups and silverware readily available for the residents upon arrival. Working stove and refrigerator observed and in proper condition. The Sharps/Knives will be stored in a locked kitchen drawer. The toxins/Cleaning solutions will be kept locked in various kitchen storage cabinets and inaccessible to residents. Medications: The medications will be stored in a locked storage cabinet located near the kitchen. Medication storage is equipped with a lock to ensure medications will not be accessible to residents. First-aid kit observed as well. Emergency: The Fire extinguishers were observed to be located throughout the facility. LPA observed the fire extinguishers to have been inspected, fully charged and dated 1/10/2026. Bedrooms: All ten (10) designated resident bedrooms were observed to be properly furnished with bed, nightstand, applicable lightening and seating. LPA observed auditory alarms within each bedroom to be in proper and working condition. Bathroom: The bathrooms will be maintained in proper condition. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Hallways: Hallway is properly lighted. Extra linens/covers will be stored in storage cabinets. Laundry Room: The laundry room is located within the hallway’s passageway leading towards bedrooms #1 to #7. All cleaning solutions and toxins will be kept stored in locked cabinets inside the laundry room. Dryer and washer observed to be in proper condition. The Garage: LPA observed there to be no garage located within the premises. Staff room: The staff room will be kept locked and inaccessible to residents. Water Temperature: The water temperature was measured within regulations. LIC809C-continued Smoke detectors: Dual interconnected smoke detectors and carbon monoxide observed to be working properly and were tested. Outside: The outside is clean, free of hazards, and properly furnished with sufficient seating. A shaded area for residents was observed as well. LPA observed a locked storage unit. Pool: No body of water located on premises. Administration: The facility has submitted an Emergency and Disaster Plan for Residential Care Facilities for the Elderly. The Component III Orientation Residential Care Facility for the Elderly (RCFE) was waived due to the Administrator’s qualifications. The facility is not yet in compliance with Title 22 Regulations at this time. The Administrator will work on the following and submit corrections to CCLD prior to approval: -Inclusion of Facility’s Program Design and Admission Agreement to reflect the use of video surveillance with no auditory use in the common areas (hallways, exterior of facility and so forth). -Bedroom locks on all ten (10) bedrooms will be fixed or removed to ensure residents’ rights are not infringed upon. -Replacement of all bedroom window coverings/screens. -One (1) of the five (5) restrooms located between room #8 and #9 will need to have completion of the shower and bathroom sink installed and in proper working condition. Once completed, this report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. Exit interview was conducted and copy of this report issued to the licensee.the state’s words, verbatim · CDSS document, Feb 23, 2026

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Feb 11, 2026