Balanced Living Board and Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:56 a.m. Upon arrival, LPA Mosley was greeted by staff who called the Administrator to inform them of the visit. The Licensee Representative, Amaliya Santiago arrived shortly after and the reason for the visit was explained. Entrance interview. The LPA and 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. The facility is a single-story home located in a residential neighborhood with an attached garage. COMMON AREAS: This includes the living room, and dining room. At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 1:12 p.m., hardwire combination of smoke / carbon monoxide detectors were tested and operational at the time of the visit. The fire extinguisher was observed and fully charged on 01/07/2026. The emergency exiting plans/sketch are posted. The emergency telephone numbers are posted in the common hallway. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 10/05/2025 and are conducted quarterly. Activities were observed in the common areas. The fireplace in the living room was adequately screened. There is a functioning telephone on the premises. INTERVIEWS: Starting at 10:05 a.m. and throughout the visit two (2) staff and two (2) resident interviews were conducted. Staff interview revealed that staff are knowledgeable in Resident rights, different forms of abuse, and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. Report Continued on LIC 809-C PAGE 2... (PAGE 2) Report Continued from LIC 809-C... KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. The kitchen faucet was measured for hot water temperature, and it measured 118.6 degrees Fahrenheit. Cleaning supplies and other chemicals are kept locked in the garage inaccessible to residents in care. BEDROOMS: There are five (5) total bedrooms in the facility; two (2) bedrooms are designated as private, single occupancy, resident rooms and two (2) shares, double occupancy, resident rooms and one (1) staff room. The staff room is kept locked at all times and observed to be occupied by staff. Two (2) out of four (4) resident rooms have exits to the exterior. All passageways were observed to be clear of obstructions. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. RESTROOMS: There are three (3) total restrooms. One (1) is designated as a shared / common resident restroom, and two (2) are designated as a private resident restrooms. Resident restrooms were observed to be equipped with a slip resistant surface / mat. Grab bars were observed in the restrooms. The restrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all resident restrooms and ranged between 105.6-116.1 degrees Fahrenheit, all within the required range. LPA observed storage space closets in the hallway containing extra clean linens and towels for resident use. GARAGE: LPA observed the attached facility garage, which was locked at the time of the visit. LPA observed emergency food and water, personal protection equipment (PPE) , incontinent supplies, cleaning supplies, and laundry units including washer, dryer and detergent. BACKYARD: The entire property is fenced. The backyard has a covered patio area with shade, patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed two (2) self-latching gates. There were no bodies of water noted at the time of the visit. Only one (1) pathway is used as an emergency exit which was free of obstructions at the time of the visit. LPA observed an RV parked on the property directly adjacent that was empty and locked at the time of the visit. Report Continued on LIC 809-C PAGE 3... (PAGE 3) Report Continued from LIC 809-C PAGE 2... RECORDS: Resident Records: Two (2) Resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All records were in order. Personnel Records Four (4) Personnel files including the Administrator’s file 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 in order. INFECTION CONTROL/ EMERGENCY DISASTER PLANNING: During today’s visit the LPA reviewed the facility’s infection control practices and the facilities emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facilities policies and procedures, as they pertain to infection control and emergency planning meet the regulatory standard. MEDICATIONS: Medication review began at approximately 2:00 p.m. Medications are centrally stored and locked in a cabinet in the kitchen adjacent to the dining room. Medications for two (2) residents were reviewed. Medication review revealed that medications for two (2) of two (2) residents were not properly documented on the centrally stored medications and destruction record with start dates which poses a potential health, safety and personal rights risk to resident in care. LPA observed the first aid supplies to be complete, including sterile first aid dressings, bandages, tweezer, a thermometer and a current version of a first aid manual. DOCUMENTS: Documents obtained during the visit include: LIC 500 facility roster and LIC 9020A Resident roster and copy of the Limited Liability insurance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. The Licensee was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. LPA initially met with facility staff and LPA explained the reason for today's visit. Licensee was contacted via telephone. Licensees Amaliya Santiago and Syuzanna Avetyan arrived at 10:35AM. Entrance interview conducted. Beginning at 01:37PM, the LPA, along with Licensees, 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 observed: Hardwired combination smoke and carbon monoxide detectors were tested at 02:44PM and were functional at the time of the visit. Fire extinguisher was observed to be fully charged but purchased on 07/21/2023. During today's visit, Licensee ordered a new fire extinguisher. Auditory alarms on exit doors were observed to be functional during the visit. KITCHEN: Kitchen knives are stored locked and inaccessible in a drawer on the right-hand side of the kitchen stove. The supply of perishable and nonperishable food is adequate. Appliances in the kitchen appeared clean and functional. GARAGE/LAUNDRY: The garage was observed adjacent to the facility kitchen. Laundry area is located in the locked attached garage. Laundry detergent and chemicals are stored inaccessible in the locked garage. There is an adequate supply of emergency food and water stored in the garage. BEDROOMS: There are 5 (five) bedrooms in the facility; 2 (two) private bedrooms for resident use, 2 (two) shared bedrooms for resident use and one (1) staff room. The staff room is kept locked. Resident rooms contained adequate lighting and were furnished appropriately. Continued on LIC 809-C BATHROOMS: There are 3 (three) full bathrooms for resident use; the bathroom located in the main hallway is designated for shared use and the other 2 (two) restrooms are designated for private resident use. All showers are equipped with nonslip surfaces and available nonskid mats. Grab bars were observed in all bathrooms. Hot water temperature in bathrooms was tested and measured within the required range. COMMON AREAS: The common areas were appropriately furnished, and the lighting was adequate. There is a television and activities available in the living room area for resident use. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted along the entrance wall. Other required postings were observed along the entrance wall. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with tables and chairs for resident use. There are no bodies of water noted on the premises. FILES: Beginning at 09:50AM, the LPA reviewed 4 (four) staff files for but not limited to: health screening, TB test, training documents, and fingerprint clearance. All staff records were in order. LPA reviewed 3 (three) resident files for but not limited to: pre-admission appraisal, physician's report, personal rights, and outside agency care plans. All resident records were observed to be complete. MEDICATIONS: Medications are stored in a locked cabinet in the kitchen. The first aid supplies were complete. Medications were reviewed for 2 (two) residents. All medications reviewed were stored and documented in accordance with regulation. INFECTION CONTROL/EMERGENCY DISASTER PLAN: During today's visit, the LPA reviewed both the facility's infection control plan and emergency disaster plan. Both documents were observed to be complete and updated annually as required. The facility conducts emergency disaster drills quarterly with the last documented drill conducted on 09/19/2024. INTERVIEWS: During the visit, LPA interviewed a random sample of staff and residents. No concerns were noted. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Jan 9, 2025

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility did not ensure that staff can effectively communicate with a resident in care.

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced initial 10-day complaint visit to the above facility. Upon arrival, LPA was greeted by facility staff Alvard Galstyan. Staff Galstayan contacted facility Administrator/Licensee Representative Amaliya Santiago via phone and the reason for the visit was explained. Administrator/Licensee Representative informed LPA that she, along with the other three (3) designated administrators are unable to be present during today’s visit and authorized facility staff Galstayan to sign and receive report. It was alleged that facility staff are unable to communicate with resident due to a language barrier. During today’s visit, at 12:05 p.m., LPA interviewed facility resident and staff. At 9:56 a.m., LPA also conducted a phone interview with facility administrator Mr. Avetik Avo Avetyan. Additionally, LPA conducted interviews with witnesses at 10:03 a.m. and at 11:35 a.m. Information gathered during the course of the investigation reflected that Staff #1 (S1) can only communicate in Spanish, Russian and Armenian; however, cannot communicate in English. Continued on LIC 9099C Substantiated Continued from LIC 9099 Upon LPA’s arrival to the facility, S1 admitted that they did not speak English and inquired if the LPA spoke Spanish. Moreover, interviews further reflected that the residents and witnesses are also unable to communicate with S1, and if they had concerns, they would contact the administrator via phone. It was also revealed that S1 would contact the administrator to translate. Based on the information gathered during the course of the investigation, the Department has sufficient evidence to determine that the facility staff are unable to communicate with resident due to language barrier. Therefore, the above allegation is deemed SUBSTANTIATED at this time. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). A telephonic exit interview was conducted with facility's Licensee and Administrator. A hard copy of the report was provided. A copy of the report and appeal rights was issued.the state’s words, verbatim · CDSS document, Jul 1, 2024 · control 29-AS-20240625130611

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Jul 15, 2024

87411(d)(3) Personnel Requirements: All personnel shal... This training and/or related experience shall provide knowledge of and skill in the following... (3) Skill... including the ability to communicate with residents. This requirement is not met as evidenced by… Based on observation, and interviews, licensee did not comply with the above section by not ensuring Staff #1 (S1) is able to communicate with facility residents and other parties, which poses a potential health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Jul 1, 2024

Plan of correction: Administrator is looking for a new staff member that speak English. Rabbit devise was purchased to facilitate communication. A in-job-trainig log will be provided by POC due date on how to use devise.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Valera Conway conducted an unannounced Case Management Deficiency visit in conjunction with an initial 10-day complaint visit (CC # 29-AS-20240625130611). Upon arrival, LPA was greeted by facility staff Alvard Galstyan. Staff Galstayan contacted facility Administrator/Licensee Representative Amaliya Santiago via phone. Administrator/Licensee Representative informed LPA that she, along with the other three (3) designated administrators are unable to be present during today’s visit and authorized facility staff Galstayan to sign and receive report. The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint. During today's visit, LPA spoke with designated facility administrator Avetik Avetyan and requested to review the facility Personnel record (LIC 500) and/or copy of the staff schedule along with a copy of the Resident/Client Roster. Administrator stated that he intended to complete a staff schedule/LIC500 and the Resident/Client Roster, however, has not completed one at this time. Administrator agreed to complete all required forms and have it readily available for licensing review. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). A telephonic exit interview was conducted with facility's Licensee and Administrator. A hard copy of the report was provided. A copy of the report and appeal rights was issued.the state’s words, verbatim · CDSS document, Jul 1, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(5) · Plan of correction due date: Jul 15, 2024

87208(a)(5)(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall... Any significant changes in the plan of operation... (5) Staffing plan, qualifications and duties.This requirement is not met as evidenced by… Based on observation, and interviews, licensee did not comply with the above section by not ensuring plan of operation documentation is being kept readily avaailable to licensing departments which poses a potential health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Jul 1, 2024

Plan of correction: Administrator shall complete a LIC 500 and post it at the facility or have it readily available for when licensing department request it. LPA expects administrator to have updated LIC 500 before POC due date. Administrator shall complete a resident roster form, post it at the facility or have it readily available for when licensing department request it. LPA expects administrator to have updated form before POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87508(b) · Plan of correction due date: Jul 15, 2024

87508 Register of Residents (b) Registers of residents shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours... This requirement is not met as evidenced by…the state’s words, verbatim · CDSS document, Jul 1, 2024

Type of visit: Prelicensing

On 01/18/2024, Licensing Program Analyst (LPA) Elsie Campos issued an amended Pre-licensing report with corrective information pertaining to the approved fire clearance. LPA spoke to the Licensee via telephone and explained the reason for the call. Licensee was not available to meet at the facility and the report was provided electronically for signature. On 1/16/2024, Licensing Program Analyst (LPA) Elsie Campos arrived at the facility announced at 10:15 a.m. to conduct a pre-licensing inspection. The LPA met with Licensee Amaliya Santiago and Applicant/Administrator Smbat Avetyan. This is a new facility application for (6) six residents’. Fire clearance was granted on 08/24/2023 for two (2) non-ambulatory residents in bedroom #1, one (1) non-ambulatory and one (1) bedridden resident in bedroom #2, one (1) ambulatory resident in bedroom #3 and one (1) ambulatory resident in bedroom # 4. Bedroom #5 is cleared as a staff room only. Component III was completed with the LPA during today’s visit and is RCFE administrator certified. At 10:45 p.m., the LPA toured the physical plant areas inside and outside with applicants to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen knives are stored locked and inaccessible in a kitchen cabinet on the right-hand side of the kitchen stove. The supply of perishable and nonperishable food is adequate. The supply of dishes is adequate. Appliances in the kitchen were new, clean and functional. There is an adequate supply of emergency food and water located in the garage. BEDROOMS: There are five (5) bedrooms in the facility; two (2) private bedrooms for resident use, two (2) shared bedrooms for resident use and one (1) staff room. The staff room is kept locked. The two (2) shared resident rooms have direct access to the outside. Lighting in the rooms was adequate. All resident rooms and staff room were set up with beds, night stands, lamps, chests of drawers, chairs and closet space. All doors have functioning audible devices. Continued on LIC 809-C BATHROOMS: There are three (3) full bathrooms for resident use; the bathroom located in the main hallway is designated for guests, staff and residents. All showers are equipped with nonskid surfaces and available nonskid mats. Grab bars were observed in all bathrooms. Hot water temperature in bathrooms measured between 115.0 – 118.5 degrees Fahrenheit.COMMON AREA: The common areas were appropriately furnished, and the lighting was adequate. There is a television and activities available in the living room area for resident use. The facility smoke alarm system is hard wired; the smoke detectors were tested at 12:20 p.m. and operable at the time of the visit. There are two (2) fire extinguishers which were fully charged and last purchased on 7/21/2023. There is a functioning telephone on the premises. Emergency exiting plans/sketch are posted. Emergency telephone numbers are posted along the entrance wall. Other required postings are also posted along the entrance wall. However, the Ombudsman poster was missing, and the Administrator made arrangements to pick one up. MEDICATIONS: Medications will be stored in a locked cabinet in the kitchen to the left upon entry. The first aid supplies were complete, including a first aid manual, and will be stored in the medication cabinet. FILES: Resident and staff records will be stored in a filing cabinet in the living room to the right of the screened fireplace. LAUNDRY: The laundry area is located in the locked attached garage. Laundry detergent and chemicals are stored inaccessible in the locked garage. EXTERIOR: The exterior passageways were clean and clear of any obstructions. There is a covered patio area in the backyard with tables and chairs for resident use. There are no bodies of water noted on the premises.The back and sides of the house are separated from the front yard by gates at the north and south side passageways. The attached garage is used for additional storage space and emergency food supply. There are no other structures on the property. INFECTION CONTROL: The facility has an area that will be used as a central entry point for symptom screening and sanitation station for staff, residents, and visitors. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. Facility is in compliance with Title 22 Regulations at this time. This report will be sent to the Centralized Application Bureau (CAB). The CAB Analyst will notify the applicant when the license has been approved. The applicant is aware that they are unable to operate under the new license number until they have been notified that the license has been approved by the CAB Analyst. Failure to comply could affect approval of the license. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Jan 16, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Amaliya Santiago, Applicant Smbat Avetyan, Administrator Syuzanna Avetyan, Applicant Interview Method: Virtual interview (Microsoft Teams) On December 12, 2023 at 11:30 AM, Applicants and Administrator participated in COMP II. Identification of the Applicants and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicants and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB analyst confirmed Applicants and Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicants and Administrator. Report sent via email and informed to return signed copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Dec 12, 2023