Blue Sky Manor

Allegation investigated: Unlawful eviction

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint received July 30, 2026. LPA Haley was greeted by staff and explained the reason for the visit upon entry. Regarding the allegation: Unlawful eviction During the investigation it was discovered, Resident 1 (R1) was sent to the hospital on July 29, 2026, due to having unwitnessed falls. According to hospital staff, after R1 was evaluated there were no signs of multiple falls. The resident was fine and ready to be discharged the same day. When the facility was contacted, R1 was not allowed to return. Hospital staff were informed by Administrator Airapetian that R1’s bed was taken and hospital staff were told that R1 did not want to return to the facility. Based on the evidence gathered during interviews, and document review the preponderance of evidence standard has been met, therefore, the allegation is found to be SUBSTANTIATED. A violation is being cited per California Code of Regulations Title 22. An exit interview was conducted, and a copy of this report and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Aug 4, 2026 · control 22-AS-20260730143439

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Aug 5, 2026

87224 (a)Eviction Procedures - The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by: Based on interview confirmation, Resident (1) was not allowed to come back to the facility after being sent to the hospital on July 29, 2026. R1 was discharged from the hospital the same day July 29, 2026. R1 was not allowed to return to the facility.the state’s words, verbatim · CDSS document, Aug 4, 2026

Plan of correction: Administrator Airapetian will read and review the regulation section on Eviction Procedures and send a signed statement of acknowledgment and understanding to LPA Haley by 4:00pm on the POC due date (8.5).

Type of visit: Collateral

On July 15, 2026, Licensing Program Analyst (LPA) Garlli Tat conducted a collateral visit in conjunction with complaint 22-AS-20260601123502. During today's visit LPA interviewed Resident #1 (R1).the state’s words, verbatim · CDSS document, Jul 15, 2026

Allegation investigated: Medication not administered as prescribed. Facility staff does not follow resident's prescribed diet. Facility is not clean.

Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to deliver the findings on the above allegations. LPA met with authorized representative Janet Walley and explained the purpose of the visit. An initial complaint investigation visit took place on May 1, 2026. During the visit, LPA accompanied by staff, conducted a tour of the facility's physical plant. LPA requested and obtained resident records for Resident 1 (R1). A subsequent visit was held on May 28, 2026. Five staff and five resident interviews were conducted during the visit. Regarding the allegation that Medication is not administered as prescribed, the following has been concluded: LPA interviewed 5 residents including R1. 3 out 5 residents reported no issues with their medication. R1 reported they believed they had medication issues but could not provide any details and were unsure of the medications they were currently taking. Continued on LIC 9099-C. Unsubstantiated The other resident interviewed (Resident 3) reported that they were unsure of what medications they were currently prescribed and could not tell the LPA how many different medications they were taking. A review of R1’s medications and MAR for April 2026 shows R1 received their 13 routine medications as prescribed except when R1 was not at the facility. R1 is prescribed 5 PRN medications which they did not request (R1 verified this information). R1 attends dialysis three times per week, which accounts for the discrepancy in the MAR. Five out of five staff reported medication is always administered as prescribed. LPA reviewed the medications and MAR (April 2026) for Resident 2, Resident 3, Resident 4 and Resident 5, no discrepancies observed. Regarding the allegation that Staff does not follow resident’s prescribed diet, the following has been concluded: A review of records shows R1’s Physician’s report dated April 7, 2026, that R1 is prescribed a low carbohydrate diabetic diet. Staff 1 reported that R1 has been prescribed a renal diet, but there is no documentation to support this report. Staff 1 reported R1 does not follow their prescribed diet and eats whatever they want. Staff 1 reported that they have attempted to talk to R1 about their diet, but R1 will not discuss it with them. R1 is on dialysis three times a week. R1 reported they are not on a renal diet; they are on a diabetic diet. Staff 1 reported that many of the residents at the facility are diabetic, so the facility menu is based on a low carbohydrate diabetic diet. Five out of five staff interviewed confirmed that R1 refuses to eat food served by the facility due to personal preferences. R1 reported they do not like the food at the facility and it is bland and usually served cold. R1 reported they prefer to eat out and eat what they want. Regarding the allegation Facility is not clean, the following has been concluded: It was reported that R1’s bathroom was not clean and had blood stains on the sink. Four out of the five residents interviewed expressed their satisfaction with the facility staff cleaning the rooms and bathrooms on a regular basis. One resident stated that their roommate was not always neat but denied that it was due to staff negligence because they stated their bathroom gets cleaned regularly. R1 reported that their room is clean but wanted help cleaning their wheelchair. R1 reported that their bathroom is clean. Four out of Four staff reported cleaning is done everyday in the facility and rooms are checked and cleaned when needed. LPA observed during the initial 10-day visit the facility and resident rooms and bathrooms were clean. LPA observed some residents were disorganized, but their rooms were clean. Continued on LIC 9099-C. Based on the evidence gathered during the investigation, the allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of the present report was provided to a facility representative.the state’s words, verbatim · CDSS document, Jun 15, 2026 · control 22-AS-20260423123841

Allegation investigated: -Staff accessed residents banking information without authorization. 2-Staff is contacting the resident online and harassing the resident.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced site visit to the facility to investigate and deliver findings regarding the above-mentioned allegations Upon arrival, Administrator (AD) Gabriel Airapetian greeted LPA Haddadin, granted entry into the facility, and was informed of the purpose of the visit. During the course of the investigation, LPA Haddadin conducted a health and safety walk-through of the facility, observed the physical plant, reviewed relevant facility records, and conducted interviews with four staff members and four residents. The investigation also included a review of records related to Resident (R1’s) admission and discharge history. Regarding the allegation that “Staff accessed resident’s banking information without authorization,” Records reviewed revealed that R1 was admitted to the facility on 03/25/2020 and discharged on 09/24/2020 under the CalOptima recuperative program. {***CONTINUE 9099C***} Unsubstantiated Records reviewed did not show documentation indicating that the facility was authorized to access, manage, or control R1’s banking information. Additionally, records reviewed did not indicate that the facility maintained banking records, financial account information, or other financial documents belonging to R1. four out of four staff interviewed denied that facility staff accessed R1’s banking information without authorization. Staff stated that the facility does not obtain, keep, maintain, or manage residents’ banking information. Four out of four residents interviewed did not provide information to support the allegation. The residents interviewed denied having knowledge of facility staff accessing residents’ banking information without authorization and did not report concerns involving staff misuse of resident financial information. Regarding the allegation that “Staff is contacting the resident online and harassing the resident,” four out of four staff interviewed denied that facility staff contacted R1 online or harassed R1. Staff denied having knowledge of any staff member contacting R1 through social media, electronic messaging, or any other online platform in a harassing, threatening, retaliatory, or inappropriate manner. Four out of four residents interviewed did not provide information to support the allegation. The residents interviewed denied having knowledge of staff contacting residents in a harassing manner and did not report concerns involving staff harassment, intimidation, retaliation, or inappropriate communication. Based on observations, interviews conducted, and records reviewed, the Department was unable to determine whether the above allegations occurred as reported. Although the allegations may have happened or may be valid, there was not a preponderance of evidence to prove or disprove that the alleged violations occurred. Therefore, the allegations are deemed unsubstantiated. An exit interview was conducted with Administrator (AD) Gabriel Airapetian. A copy of this report was discussed with and provided to AD Gabriel Airapetian at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 16, 2026 · control 22-AS-20240118162702

Allegation investigated: -Facility is not following COVID-19 Guidelines 2-Facility is not providing adequate food service 3-Facility does not have a menu 4-Facility is not providing activities to residents 5-Facility does not allow residents to select their own pharmacies

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced site visit to the facility to investigate and deliver findings regarding the above-mentioned allegations. Upon arrival, Administrator (AD) Gabriel Airapetian greeted LPA, granted entry into the facility, and was informed of the purpose of the visit. During the course of the investigation, LPA conducted a health and safety walk-through of the facility, observed the physical plant, reviewed relevant facility records, and conducted interviews with four staff members and four residents. Regarding the allegation that “Facility is not following COVID-19 Guidelines,” During the health and safety walk-through, LPA observed the facility to be clean, orderly, and sanitary. Common areas, resident rooms, restrooms, and dining areas were observed to be maintained without any immediate health and safety concerns. {***CONTINUE***90999C} Unsubstantiated LPA observed that infection control supplies were available at the facility, including hand soap, paper towels, and cleaning supplies. LPA reviewed the Infection Control Plan for the facility and saw it to be up-to-date. Also, four out of four Staff interviewed denied the allegation and stated that the facility offers masks when asked and housekeeping carries out routine cleaning. Four out of four residents interviewed did not report concerns regarding the facility’s infection control practices or COVID-19 precautions Regarding the allegation that “Facility is not providing adequate food service,” LPA conducted a review of facility, documentation, observations, and interviews. During the investigation, LPA reviewed facility invoices dated February 27, 2026, which confirmed that food services are provided by an outside catering vendor. The vendor prepares meal courses, including breakfast, lunch, and dinner, directly at the facility. The facility also employs full-time kitchen staff who assist the vendor with meal preparation and food service. LPA reviewed Food Handler Certificates for relevant staff, which were observed to be active and valid until April 1, 2029. During the health and safety walk-through, LPA observed residents eating breakfast that was consistent with the scheduled menu. The meal observed consisted of yogurt with granola and berries, with additional options of scrambled eggs and ham. Four out of four staff interviewed denied the allegation and stated that residents are consistently provided meals of adequate quality and quantity. Staff also stated that residents have access to snacks and beverages throughout the day and may request meal alternatives if they do not prefer the scheduled meal option. All four Residents interviewed denied concerns regarding food quality, portion size, meal availability, or the facility’s ability to provide regular meals. Regarding the allegation that “Facility does not have a menu,” LPA reviewed facility records and observed the facility’s posted menu during the visit. During the record review, LPA confirmed that the facility maintains an active and structured menu. LPA also observed that residents were being served in a manner consistent with the facility’s posted menu and food service practices. All four staff interviewed denied the allegation and stated that the facility maintains a menu for resident meals.{***CONTINUE***90999C} Also, all four residents interviewed did not report concerns regarding the facility not having a menu, and no evidence was obtained to show that the facility failed to maintain or follow a menu. Regarding the allegation that “Facility is not providing activities to residents,”. Four out of four Staff interviewed denied the allegation and stated that residents are offered activities based on their interests, abilities, and participation preferences. Staff reported that activities may include socialization, television, music, games, and other resident-centered activities. Four out of four residents interviewed denied concerns regarding the facility failing to provide activities and did not report that they were prevented from participating in activities. During the visit, LPA did not observe any immediate concerns related to resident engagement or lack of access to activities. LPA also observed that the facility has a dedicated room designed for residents’ activities which has a large TV puzzles and other activity supplies. Regarding the allegation that “Facility does not allow residents to select their own pharmacies,” all four Staff interviewed denied the allegation and stated that residents, responsible parties, or authorized representatives may select a pharmacy of their choice. Staff further stated that the facility may provide pharmacy information or coordination assistance only when requested; however, residents are not required to use a specific pharmacy. LPA reviewed 4 residents’ files and observed that all four have different pharmacies from one another. Also, all four Residents interviewed did not report being denied the right to choose their own pharmacy and did not express concerns. Based on observations, interviews, and records reviewed, the Department is unable to determine whether the above allegations occurred as reported. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the alleged violations occurred. Therefore, the allegations are deemed unsubstantiated. An exit interview was conducted with Administrator (AD) Gabriel Airapetian. A copy of this report was discussed with and provided to AD Gabriel Airapetian at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 16, 2026 · control 22-AS-20230227162125

Allegation investigated: -Staff does not provide a good quality of food to residents in care. 2-Staff do not meet the needs of resident in care.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced site visit to the facility to investigate and deliver findings regarding the allegations that “Staff does not provide a good quality of food to residents in care” and “Staff do not meet the needs of resident in care.” Upon arrival, Administrator (AD) Gabriel Airapetian greeted LPA, granted entry into the facility, and was informed of the purpose of the visit. During the course of the investigation, LPA conducted a health and safety walk-through of the facility, observed the physical plant, reviewed relevant facility records, and conducted interviews with four staff members and four residents. LPA also reviewed information related to the facility’s food service practices, staffing support, and the residents’ care needs. {***CONTINUE 9099C1***} Unsubstantiated Regarding the allegation that staff does not provide a good quality of food to residents in care, LPA conducted a review of facility operations, documentation, observations, and interviews. During the investigation, LPA reviewed facility invoices dated February 27, 2026, which confirmed that food services are provided by an outside catering vendor. The vendor prepares meal courses, including breakfast, lunch, and dinner, directly at the facility. The facility also employs full-time kitchen staff who assist the vendor with meal preparation and food service. LPA reviewed Food Handler Certificates for relevant staff, which were observed to be active and valid until April 1, 2029. During the record review, LPA confirmed that the facility maintains an active and structured menu. This information was further supported during the health and safety walk-through, during which LPA observed residents eating breakfast that was consistent with the scheduled menu. The meal observed consisted of yogurt with granola and berries, with additional options of scrambled eggs and ham. LPA also observed that residents were being served in a manner consistent with the facility’s posted menu and food service practices. As part of the investigation, LPA conducted interviews with four staff members and four residents. All four staff members denied the allegation and stated that residents are consistently provided meals of adequate quality and quantity. Staff reported that food service is consistent with the facility’s posted menu and that residents have access to snacks and beverages throughout the day. Staff further stated that residents may request meal alternatives if they do not prefer the scheduled meal option. All four residents interviewed also denied the allegation and reported that the food provided by the facility is adequate. None of the residents interviewed expressed concerns regarding food quality, portion size, meal availability, or the facility’s ability to provide regular meals. Regarding the allegation that “Staff do not meet the needs of resident in care,” LPA interviewed four staff members and four residents. All four staff members denied the allegation and stated that staff assist residents with care needs, supervision, activities of daily living, medication assistance, meals, and general support based on each resident’s individual needs and care plan. All four residents interviewed also denied the allegation and reported that staff are available to assist them when needed. {***CONTINUE 9099C2***} Residents interviewed did not report neglect, unmet care needs, or concerns regarding staff failing to provide assistance. During the facility walk-through, LPA observed residents’ rooms to be clean, orderly, and sanitary, with no debris, litter, or odors noted. Resident rooms were equipped with clean bedding, fresh linens, and necessary hygiene supplies. Restrooms were observed to be operational, well-maintained, and stocked with incontinence supplies as needed. LPA also tested the facility’s call button system and confirmed that the equipment was functional and that staff responded to alerts in a timely manner. Based on LPA’s observations, there were no immediate health and safety concerns identified during the visit related to unmet resident care needs. Based on observations, interviews, and records reviewed, the Department is unable to determine whether the above allegations occurred as reported. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the alleged violations occurred. Therefore, the allegations are deemed unsubstantiated. An exit interview was conducted with Administrator (AD) Gabriel Airapetian. A copy of this report was discussed with and provided to AD Gabriel Airapetian at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 9, 2026 · control 22-AS-20240624112308

Type of visit: Collateral

Licensing Program Analyst (LPA) Hanna Gough made an unannounced collateral visit to conduct an interview with Resident #1 (R1) in congruent to complaint control #22-AS-20260106122151. LPA was greeted and granted entry by staff. LPA met with Administrator(AD) Gabriel Airapetian and discussed the purpose of the visit. An exit interview was conducted and a copy of this report was provided to AD at the time of the visit.the state’s words, verbatim · CDSS document, May 6, 2026

Allegation investigated: Facility does not have sufficient resources to operate.

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to deliver findings regarding the above-mentioned allegation. Upon arrival, LPA Haddadin was greeted and granted entry by Administrator Assistant Sonya Tatunts It was alleged that “Facility does not have sufficient resources to operate.” The investigation determined as follows: The Department conducted a solvency audit after receiving an allegation that the licensee was behind on utility payments and at risk of service interruption. The audit reviewed the facility's October 2025 Profit and Loss report, balance sheet, bank statements, utility bills, lease documentation, and insurance records. Per a review of the October 2025 Profit and Loss report provided by the Licensee, the facility had a net loss of ($26,373.91). The licensee reported $125,013.37 in revenue across four categories, but the Department was only able to verify revenue earned from one of the revenues. {***Continue9099C***} Substantiated When asked to support the remaining reported revenue, the licensee did not provide sufficient deposit clarification, and transfers between accounts indicated resident income was not consistently deposited into the facility business checking account. Balance sheet reviewed showed the facility had a negative working capital of $422,273.45. Bank records further showed the licensee did not maintain cash reserves comparable to one month of operating expenses, and a negative ending balance was noted in March 2025. Utility review showed late charges and disconnection notices during three of the six months reviewed, with no payments made for May, July, September, and October 2025, although Southern California Gas and Spectrum bills were paid timely for the months reviewed. Therefore, based on records reviewed, the preponderance of evidence standard has been met. The allegation that the “facility does not have sufficient resources to meet operating costs for care of residents” is deemed to be SUBSTANTIATED. The facility is being per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Assistant Sonya Tatunts, and a copy of this report, LIC 9099-D, and appeal rights were provided at the time of exit.the state’s words, verbatim · CDSS document, Apr 9, 2026 · control 22-AS-20251015143305

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87213 · Plan of correction due date: Apr 13, 2026

87213 The licensee shall have a financial plan that conforms to the requirements of Section 87155 that assures sufficient resources to meet operating costs for care of residents; may be required upon the written request of the licensing agency. The balance sheet and Profit and Loss Report revealed that the facility lacks sufficient operating funds and cash reserves, has paid utility bills late, and is operating at a net loss, which poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: Licensee will have a financial plan drawn by E mailed to LPA by POC due date

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management deficiency visit; this visit is associated with complaint number: 22-AS-20251015143305 . Upon arrival, LPA Haddadin was greeted and granted entry by Assistant Administrator Sonya Tatunts The Department conducted a solvency audit and reviewed the facility’s Profit and Loss Report, balance sheet, bank statements, utility bills, lease documentation, and insurance records. The records showed the facility was operating at a net loss, did not maintain sufficient cash reserves, and had late utility payments, including disconnection notices. The Department also found that not all reported revenue could be verified and that resident income was not consistently deposited into the facility’s business account. Based on the information obtained, the licensee did not exercise general supervision over the financial affairs of the facility in a manner consistent with the facility’s operation and the welfare of residents in care, as required by Section 87205(a), Accountability of Licensee Governing Body. ONE deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights provided to Administrator Assistant Sonya Tatuntsat end of inspection.the state’s words, verbatim · CDSS document, Apr 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87205(a) · Plan of correction due date: May 18, 2026

Accountability of Licensee Governing Body 87205 (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility… This requirement was not met as evidence by licensee did not exercise general supervision over the financial affairs of the facility in a manner consistent with the facility’s operation and the welfare of residents in care, as required by Section 87205(a), Accountability of Licensee Governing Body which poses a potential Health, Safety, and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 9, 2026

Plan of correction: Licensee will have a financial plan drawn by E mailed to LPA by POC due date

Allegation investigated: Facility did not provide a total daily diet of sufficient quality to meet the resident's needs. Facility did not administer medications as prescribed.

licensing Program Analyst Samer Haddadin conducted an unannounced site visit to the facility to investigate allegations regarding the "Facility did not administer medications as prescribed" and the "Facility did not provide a total daily diet of sufficient quality to meet the resident’s needs." Upon arrival,Mayra Jimenez AD Assistance greeted the Licensing Program Analyst and granted immediate entry to the premises to begin the investigation. Regarding the allegation that the "Facility did not administer medications as prescribed," Licensing Program Analyst Haddadin reviewed the admission records for Resident 1, who was admitted to the facility on December 18, 2025. During the course of the investigation, the Licensing Program Analyst interviewed four staff members. Each staff member consistently reported that Resident 1 occasionally refuses to take prescribed medications. {***CONTINUE 9099C ****} Unsubstantiated They noted that while they explain the importance of medication compliance and the potential health consequences of refusal, they are professionally and legally obligated not to force a resident to take medication against their will. These statements were further supported by an interview with Resident 1 conducted on April 1, 2026, in which they admitted to refusing medication when they do not feel well. Resident 1 also confirmed that staff members consistently attempt to encourage them to remain compliant. Furthermore, an interview with one of four residents corroborated that Resident 1 refuses medication and that staff are seen encouraging them to take it. The remaining three residents interviewed were unable to provide information regarding this specific allegation. Furthermore, during a records review of the Medication Administration Record (MAR) dated March 19th, 25th, 27th, and 28th of 2026, it was shown that Resident 1 refused their medication. The second allegation concerned whether the "Facility did not provide a total daily diet of sufficient quality to meet the resident’s needs." The Licensing Program Analyst’s review of Resident 1’s records indicated that they were not on a special or restricted diet. During a health and safety walk-through, the Licensing Program Analyst observed the lunch service in progress. The meal being served to all residents consisted of beef empanadas accompanied by mixed fruits and vegetables. This meal was verified against the facility’s current posted menu and was found to be in full compliance with dietary standards. Based on the information gathered during the investigation, including interviews conducted and documents reviewed, the Department is unable to determine whether the above allegations occurred as reported. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the alleged violations occurred. Therefore, the allegations are deemed unsubstantiated. An exit interview was conducted, and a copy of this report was discussed with and provided to Mayra Jimenez AD Assistancethe state’s words, verbatim · CDSS document, Apr 1, 2026 · control 22-AS-20260113095313

Allegation investigated: Staff overcharged for services not received

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to deliver findings regarding the above-mentioned allegation. Upon arrival, LPA Haddadin was greeted and granted entry by Administrator (AD) Gabriel Airapetlan. It was alleged that “Staff overcharged for services not received.” LPA conducted interviews with three staff members, all of whom stated that Resident 1 (R1) was never admitted to the facility and that R1’s Responsible Party (RP) paid to reserve a room for R1. LPA also interviewed three residents, all of whom denied any knowledge of the allegation. In addition, LPA conducted a telephone interview with R1’s RP, who stated that $1,856.66 was paid to reserve the room. The RP further stated that the amount was refunded on March 26, 2026, and that no other complaints or concerns arose. {***CONTINUE9099C***} Unsubstantiated A review of email communications between the Administrator and the RP confirmed the agreement regarding the room reservation and the receipt of the refund in the amount of $1,856.66. Based on the information gathered during the investigation, including interviews conducted and documents reviewed, the Department is unable to determine whether the above allegation occurred as reported. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the alleged violation occurred. Therefore, the allegation is deemed unsubstantiated. An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator (AD) Gabriel Airapetlan.the state’s words, verbatim · CDSS document, Mar 26, 2026 · control 22-AS-20260306125010

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit for the purpose of completing a required annual inspection. Upon arrival, LPA Haddadin was greeted and granted entry by Administrator (AD) Gabriel Airapetlan. LPA Haddadin and the AD conducted a tour of the interior and exterior of the facility, including common areas, resident rooms, the kitchen, and the medication room. The facility is a large commercial facility consisting of a one-story building with 25 bedrooms and 27 bathrooms. LPA Haddadin inspected seven resident bedrooms and observed the bedrooms were spacious and able to accommodate residents’ furnishings. Each of the seven bedrooms inspected contained the required furnishings, including a bed, chair, adequate closet space, and ample lighting. LPA Haddadin inspected seven resident bathrooms and observed they were clean, with operational faucets and toilets. Water temperatures were tested and measured between 117.5 degrees Fahrenheit and 118.0 degrees Fahrenheit in the bathrooms inspected. LPA Haddadin also reviewed the posted Emergency Phone Numbers, facility Exit Plan, and menu. LPA Haddadin observed the facility maintained the required food supply, including one week of nonperishable foods and two days of perishable foods. The facility is contracted with Aizen Fire Protection. Based on record review, the fire alarm system, carbon monoxide detectors, and smoke detectors were tested and serviced on March 31, 2025. Fire extinguishers were observed to be fully charged, with service tags dated March 23, 2025. During record review, LPA Haddadin observed fire drills are conducted quarterly, with the most recent drill completed on November 24, 2025. LPA Haddadin inspected the stove burners, microwave, washers, and dryers and found them to be in operable condition. Knives were observed to be secured and inaccessible to residents. Chemical supplies were observed to be stored in a locked housekeeping room. The medication room was observed to be locked. LPA Haddadin reviewed seven resident files and five staff files and inspected medications for seven residents. All resident and staff records reviewed were current and up to date, and medications inspected were appropriately maintained. Based on observations and records reviewed during today’s visit, no deficiencies were noted in the areas inspected in accordance with Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to the AD.the state’s words, verbatim · CDSS document, Jan 6, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility and was granted entry by Administrative Assistant (AA) Sonya Tatunts. The purpose of this visit was to amend complaint number 22-AS-20251015143305. LPA reviewed and discussed the amendment with facility representatives. An exit interview was conducted, and a copy of this report, along with the amended complaint report, was provided to Administrative Assistant (AA) Sonya Tatunts .the state’s words, verbatim · CDSS document, Nov 7, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility and was granted entry by Administrative Assistant (AA) Sonya Tatunts. Administrator (AD) Gabriel Airapetian arrived shortly thereafter. The purpose of the visit was to follow up on a Special Incident Report (SIR) that the facility submitted to the Community Care Licensing (CCL) office on October 7, 2025, regarding the death of an individual who resided at the facility. The deceased individual was not an RCFE resident but was placed at the facility through a CalOptima referral, as the facility accepts such placements. LPA Haddadin reviewed documentation from Anaheim Regional Medical Center (AHMC), which indicated that the individual had been admitted on September 24, 2025, due to complaints of lower body pain. The individual remained under hospital care until October 6, 2025, when they were discharged at approximately 11:30 p.m. and transported to the facility via ambulance. On the morning of October 7, 2025, during routine rounds, the facility staff discovered the individual to be unresponsive. The facility immediately contacted 911 and was instructed by the emergency operator to initiate CPR until the Anaheim Fire Department arrived and assumed life-saving measures. The individual was transported back to AHMC, where they were pronounced deceased at 9:46 a.m. the same morning. LPA Haddadin conducted a health and safety case management visit and did not observe any deficiencies. An exit interview was conducted with the Administrator, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility and was granted entry by Sonya Tatunts. The purpose of the visit was to obtain additional relevant documentation and conduct further interviews regarding a prior complaint (Complaint Number 22-AS-20250522090334). An exit interview was conducted, and a copy of this report was provided to the appropriate party.the state’s words, verbatim · CDSS document, Aug 13, 2025

Allegation investigated: Staff engaged in inappropriate interactions with resident in care Staff made inappropriate comments towards residents in care Staff illegally evicted resident in care

Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced and met with Program Director Sona Hakobyan to deliver findings for the above complaint allegations. During the investigation, the department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: ***Report continued on 9099-C*** Unsubstantiated Allegation: Staff engaged in inappropriate interactions with resident in care-Unsubstantiated LPA conducted interviews with facility staff and resident to investigate this allegation. Staff interviews indicated that they have not witnessed another staff member act inappropriately towards residents. Resident interviews revealed they have not had a staff member be inappropriate towards them. Resident interviews further revealed they have good interactions with facility staff. During visit LPA observed staff to have a positive interaction with residents in care. Allegation: Staff made inappropriate comments towards residents in care-Unsubstantiated During the department’s investigation, LPA conducted interviews with staff and residents. Resident interviews revealed that they have never had staff at the facility yell or talk to them in an inappropriate way. Interviews with staff indicated that they have never heard another staff speak inappropriately to residents in care. During visit LPA observed staff to have a positive interaction with residents in care. Allegation: Staff illegally evicted resident in care- Unsubstantiated Interview with Program Director revealed that Resident #1 (R1) was not evicted from the facility. R1 had left the facility in December of 2024 as a self exit. R1 had packed up their belongings and left the facility. R1 was part of the facilities recuperative care. LPA was unable to interview R1. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. At this time no citations were issued. Exit interview was conducted and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 11, 2025 · control 22-AS-20241220082554

Type of visit: Case Management - Other

On 07/11/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a case management visit. LPA met with Program Director Sona Hakobyan and explained the purpose of the visit. The purpose of the case management visit is to follow up on a meeting the facility had with the Regional Office on 05/30/2025. During today’s visit, the LPA is requesting the following documents: · LIC 200 · Current plan floor Program Director stated facility is still working on obtaining the building permit. LPA obtained the documents during today’s visit. Exit interview and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Jul 11, 2025

Allegation investigated: Facility overcharged residents for care. Facility did not have a designated staff who is primary responsibility for food planning, preparation and service. Facility staff allowed residents to use illict drugs on the premises.

LPA Samer Haddadin conducted an unannounced 10-day complaint visit and to present findings regarding several reported allegations. Upon arrival, LPA Haddadin was greeted by the Program Director, Sona, who granted full access to the facility. The investigation included a tour of the premises, interviews with staff members, and a thorough review of all records pertaining to the alleged incidents involving resident (R1). The investigation first addressed the allegation that the facility overcharged residents for care. A review of facility and resident files indicated that R1 was admitted in December 2022 under the CalOptima recuperative care program. R1's monthly out-of-pocket cost was $900.00, while other residents paid between $1,300.00 and $2,800.00. The records also showed that R1 had failed to pay their dues for August and October 2024 and had only made partial payments of $250.00 for both July and September 2024. CONTINUE ***9099C** Unfounded Regarding the second allegation, which claimed the facility lacked a designated staff member for food services, the investigation found otherwise. During the facility tour, it was observed that food was handled by a certified employee. This individual holds an Accredited Certification issued on May 24, 2024, which remains valid until May 24, 2027. Finally, the investigation looked into the allegation that facility staff allowed residents to use illicit drugs on the premises. A review of facility records confirmed a policy of conducting random drug tests for all CalOptima residents. Records for tests administered on October 7 and October 8, 2024, showed that all fifteen CalOptima residents tested had negative results. Therefore, based on the preponderance of evidence gathered through interviews and the review of all pertinent records, the allegation that the " Facility overcharged residents for care. Facility did not have a designated staff who is primary responsibility for food planning, preparation and service. Facility staff allowed residents to use illicit drugs on the premises." was found to be Unfounded. This determination means the allegation was proven to be false, could not have happened, or is without a reasonable basis. No deficiencies were cited during the visit. An exit interview was conducted with Program Director Sona, who was provided with a copy of this report.the state’s words, verbatim · CDSS document, Jun 13, 2025 · control 22-AS-20250603161747

Allegation investigated: Unlawful eviction. Staff is deliberately not submitting residents paperwork to appropriate agency causing a delay in processing required paperwork

LPA Samer Haddadin conducted an unannounced complaint visit to present findings regarding two reported allegations. Upon arrival, LPA Haddadin was greeted by the Program Director, Sona, who granted full access to the facility. The investigation included a tour of the premises, interviews with staff members, and a thorough review of all records pertaining to the alleged incidents involving resident (R1). The investigation addressed the following allegations: First, regarding the allegation of an "unlawful eviction," a review of facility records was conducted. No record of the facility issuing any type of eviction notice to Resident 1 (R1) was found. Furthermore, during an interview with LPA Haddadin, R1 admitted that the facility had not given them any written or verbal eviction notice. Second, regarding the allegation that "staff is deliberately not submitting residents' paperwork to the appropriate agency, causing a delay in processing," a record review Unfounded was also performed. It was noted that the facility had submitted a claim to CalOptima on behalf of R1. This claim resulted in a denial of benefits due to the depletion of all of R1's available benefits. Therefore, based on the preponderance of evidence gathered through interviews and record reviews, the allegations of "unlawful eviction" and "staff deliberately not submitting residents' paperwork to the appropriate agency causing a delay" were found to be Unfounded. An unfounded determination means the allegations were determined to be false, could not have happened, and/or are without a reasonable basis. No deficiencies were cited during today's visit. An exit interview was conducted with the Program Director, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 13, 2025 · control 22-AS-20250522090334

Type of visit: Office

An informal conference was conducted on this date in the Orange County Adult and Senior Care Regional Office to discuss CalOptima contract and the facility's plan of operation. Present during this meeting were Regional Manager (RM) Marina Stanic, Licensing Program Manager (LPM) Lourdes Montoya, Licensing Program Analysts (LPAs) Samer Haddadin, Jessica Cho, Licensee/CEO Albert Zakaryan, Administrator Gabriel Airapetian, Program Director Sona Hakobyan, and Attorney Jack Zakaryan. The following items were discussed during the meeting: The licensees' desires to operate the RCFE for elderly residents. The CalOptima contract was in place to support full occupancy. The solution to support the licensee's intent to operate RCFE and have full occupancy was to decrease the facility capacity from 50 to 22 residents and to separate the wing for independent residents so that the commingling of residents would not be possible. Licensee will submit the Application for a Community Care Facility or Residential Care Facility for he Elderly License (LIC200) and floor plan no later than Friday, June 6, 2025 requesting a decrease in capacity. It is understood that the licensee will submit the LIC200 and floor plan for increase in capacity if there is a demand for placement. Facility will maintain compliance of Title 22 regulations during the transition. An exit interview was conducted with Licensee/CEO Albert Zakaryan, Administrator Gabriel Airapetian, Program Director Sona Hakobyan, and Attorney Jack Zakaryan, and a copy of this report was provided at the end of the meeting.the state’s words, verbatim · CDSS document, May 30, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Jessica Cho and Samer Haddadin arrived at the facility unannounced on a Case Management- Deficiencies visit. Deficiency was observed during the investigation conducted on March 18, 2025 into Complaint Control #: 22-AS-20250127111244. LPAs met with Program Director Sona Hakobyan and explained the purpose of the visit. LPA requested copies of pertinent resident documentation which includes the Resident Roster identifying residents enrolled in the health insurance program, Personnel Report Summary, and pertinent resident information. During the course of the investigation mentioned above, it was determined that residents, under the publicly funded health insurance plan, are temporarily housed at the facility on short term. Based on the review of the plan of operation, the licensee is not operating the facility in accordance with the terms specified in the plan of operation approved by the Department by not adhering to their program description and has acknowledged that the program was introduced after licensure. Therefore, based on observations, interviews, and record review, a deficiency is being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. Refer to the LIC809-D. An exit interview was conducted with Administrator Gabriel Airapetian in person and on the phone with Chief Executive Officer Albert Zakaryan, and a copy of this report and appeal rights were provided at exit.the state’s words, verbatim · CDSS document, May 1, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: May 9, 2025

87208 Plan of Operation (a) "The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so..." This requirement was not met as evidenced by: Based on interviews and record review, the facility is/did not comply with the section cited above by not adhering to the plan of operation approved by Department which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, May 1, 2025

Plan of correction: Licensee stated that they will seize accepting residents from the health insurance program, to not evict those residents, and to submit a request in writing in a change of operation to serve different types of residents via email to LPAs Cho and Haddadin by POC due date.

Allegation investigated: Staff illegally evicted resident in care. Staff are withholding a resident’s personal belongings. Unqualified staff are giving insulin injections to residents in care. Staff are administering a resident’s prescribed insulin to other residents in care.

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Administrator (AD) Gabriel Airapetian and Program Director (PD) Sona Hakobyan and explained the reason for the visit. LPA and the PD toured the facility. LPA interviewed staff and residents. LPA reviewed resident records. The investigation into the allegation, staff illegally evicted resident in care, revealed the following. It was alleged that on or around March 16, 2025 Resident 1 (R1) was told by the PD that they needed to move out of the facility and were no longer welcome at the facility. The PD denied this allegation. 4 out of 4 staff interviewed reported they never witnessed any staff member telling R1 they needed to move out of the facility. The PD reported that on March 16, 2025, staff called around 10:00pm because R1 was disturbing residents. The PD reported they spoke to R1 on the facility phone and informed R1 they needed to comply with house rules because their behavior was disturbing other residents who wanted to sleep. R1 reported that this conversation took place in person because the PD was at the facility. Staff 1 (S1) reported the conversation was on the phone. After the call R1 walked away. Unsubstantiated R1 reported they moved out of the facility and left that night because the PD had evicted them verbally. The PD reported that R1 was never evicted, never given an eviction notice and was never told they had to leave. R1 verified they were never given an eviction notice. R1 reported that they were not forced out and left of their own free will on March 16, but they didn't feel welcome at the facility. Based on the evidence gathered the allegation is deemed unsubstantiated, meaning although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Regarding the allegation, staff are withholding a resident’s personal belongings, the investigation revealed the following. It was alleged that after R1 moved out the facility, facility staff would not let R1 have their belongings. It was reported that on or around April 11 R1 went to the facility to pick up their belongings but staff told R1 they were too busy and could not help them. Staff 2 who was present reported that R1 was given all of their belongings but was upset it was not in boxes. R1 left and only took some of the their belongings. The (PD) reported R1's belongings are in storage and they can come and pick them up anytime from 9:00 am to 5:00 pm. LPA observed numerous items in facility storage. The PD reported and showed the items that are reported to be R1's belongings. Due to conflicting information being reported from R1 and the facility staff the allegation, staff are withholding a resident's personal belongings is deemed unsubstantiated, meaning although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, unqualified staff are giving insulin injections to residents in care, revealed the following. It was alleged that medication technicians (med-techs) were administering injections to residents. LPA interviewed 3 med-techs who reported that they do not administer insulin injections to any residents. LPA interviewed 4 residents who reported they administer their own insulin injections. R1 reported that med-techs administered her insulin injections. Due to conflicting information reported it cannot be determined what transpired. Therefore the allegation is deemed unsubstantiated, meaning although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, Staff are administering a resident’s prescribed insulin to other residents in care, revealed the following. It was reported that R1's insulin was being administered to other residents. LPA interviewed 3 med-techs who denied the allegation. LPA interviewed 4 residents who reported they receive their own medication and not anyone else's medication. LPA reviewed 4 resident medications, no discrepancies observed. Based on the evidence gathered the allegation is deemed unsubstantiated, meaning although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Apr 29, 2025 · control 22-AS-20250423095033

Allegation investigated: Unlawful eviction.

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of continuing the complaint investigation into the above allegation. LPA was greeted and granted entry by Administrative Assistant (AA) Sonya Tatunts. Administrator (Admin) Sona Hakobyan arrived approximately 9:00am and Finance Manager (FM) Gabriel Airapetian around 11:00am. On January 27, 2025, the Department received the complaint regarding the unlawful eviction of the Short-Term Post Hospitalization House (STPHH) residents under the Recuperative Care Program (RCP) regulated by a different entity. The complaint was initiated by LPA on January 29, 2025. During the course of the investigation, LPA interviewed seven residents and four staff and obtained pertinent documentation which includes the Resident Rosters, Personnel Reports, Face Sheets, Medical Records, Eviction Notices/rescinded Eviction Notice, and Plan of Operations. Substantiated Regarding the allegation, Unlawful eviction, it was reported that the STPHH residents are unlawfully evicted by the facility. The investigation revealed the following: Based on the random review of the records of seven residents, two residents are under RCP and five with the STPHH. Five out of the seven residents interviewed confirmed receiving an eviction notice on or around January 24, 2025 and refused to move out. As of today's date, three STPHH residents moved out after receiving the eviction notices which was corroborated by three out of three staff. At this time, facility is not in compliance with the regulatory requirements outlined in the Title 22, Eviction Procedures, as the eviction notices did not include but is not limited to the following: the effective date/reason for the eviction, current service plan, relocation evaluation, list of referral agencies, seeking approval from the Department, and etc. Therefore, based on the interviews which were conducted and the records that was reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Unlawful eviction is deemed SUBSTANTIATED. A deficiency is being cited on the attached LIC9099-D as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. An exit interview was conducted with Administrator Sona Hakobyan and Finance Manager Gabriel Airapetian who was present on the telephone call, and a copy of this report including the LIC9099-C & D, and appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Mar 18, 2025 · control 22-AS-20250127111244

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)-(i) · Plan of correction due date: Mar 31, 2025

87224 Eviction Procedures (a)-(i) This requirement was not met as evidenced by: Based on the interviews and record review, facility did not issue valid eviction notices to STPHH residents which poses a potential Health, Safety, and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 18, 2025

Plan of correction: Administrator stated that they will provide a copy of 87224 and a written notice to all current STPHH residents rescinding the initial notice issued on or around 1/24/25 and a meeting will be conducted with all residents discussing the eviction procedures and will obtain signatures from residents attending the meeting. A copy of the attendance sheet will be emailed to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jessica Cho continued the visit after delivering the findings in connection to Complaint Control #: 22-AS-20250127111244. LPA explained the purpose of this subsequent visit to Administrator (Admin) Sona Hakobyan. During the visit, LPA obtained copies of two Plan of Operations, and reviewed records of three residents under the Short Term Post Hospitalization Program (STPHH). Based on the review of the records, facility did not maintain complete records such as the Admission Agreement and Personal Rights in Privately Operated Residential Care Facilities for the Elderly (LIC613C-2). According to Admin Hakobyan, Admission Agreements are not provided under the Recuperative Care and STPHH Programs as residents are admitted to the facility for a short term stay. Therefore, based on observations, interview, and record review, a deficiency is being cited per Title 22 Division 6 Chapter 8 of the California Code of Regulations. See LIC809D. An exit interview was conducted with Administrator Sona Hakobyan, and a copy of this report along with the LIC811, LIC809D, Title 22 Regulations 87506 & 87507, and the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Mar 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Mar 31, 2025

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on observation, interview, and record review, facility did not maintain complete records in three out of three residents which poses a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 18, 2025

Plan of correction: Administrator stated that all CCL required forms will be completed and maintained for all STPHH and Recuperative Care residents moving forward and will either also complete missing forms for current residents OR close the program per the licensee's decision by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry by Admin Sona Hakobyan. LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and medication room and observed the following: Structure: this is a large commercial facility. Facility is a 25-bedroom, 27-bathroom, 1 story building. Resident Bedrooms: the 7 resident bedrooms inspected are spacious and easily accommodate the residents’ furnishings. Furniture for 7 resident bedrooms inspected including bed, chair, closet space, and ample lighting. Bathrooms: the bathrooms were clean; faucets and toilets were operational. Water temperature: tested between 120.00 degrees F and 115.5 degrees in the 7 resident bathrooms inspected. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed facility has one week of non-perishables foods and two days of perishables foods available as required by regulations. The Facility is contracted with Aizen Fire protection which according to record review, the facility had the fire alarm, Carbon Monoxide and Smoke Detectors tested and serviced on May 22nd, 2024. Fire Extinguishers were fully charged with Service tags dated on November 23rd, 2024. During record review LPA observed that Fire drills are being conducted quarterly with last drill on December 12th, 2024. Appliances: stove burners, microwave, washers, and dryers inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the housekeeping room. Medication room: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. LPA reviewed 7 resident files and 5 staff files, and inspected medications for 7 residents; All residents’ and employes’ records are current and up to date. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 31, 2024

Allegation investigated: Staff require residents to purchase medications from a particular pharmacy. Staff did not ensure resident's medication was available at the facility.

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of continuing the investigation and delivering the findings into the above allegations. On September 17, 2024, LPAs Jessica Cho and Edward Kim initiated the 10-day complaint investigation. LPAs interviewed six out of eight residents and two staff however interviews were denied by the two residents. Pertinent documentations were obtained such as the Resident Roster, Staff Roster, Face Sheets, six out of eight residents’ Medication Administration Records (MARs) and Physician’s Reports or Medical Records. On September 25, 2024, LPA Cho continued the investigation and obtained additional records such as the Resident Roster, Narcotic Inventory Sheet, and Recuperative Care Program Policy and Procedures. Subsequent interviews were conducted with the two staff and one additional staff. On today’s date, LPA continued the interviews with two staff and obtained additional records such as the Narcotic Inventory Sheet, R1’s medical discharge summaries, and Resident’s Pharmacy Assignment List. Unsubstantiated The investigation revealed the following: It is alleged that the staff requires residents to purchase medications from a particular pharmacy. One out of six residents and one out of the three staff confirmed the allegation stating that the facility recommends certain pharmacies and feels like the resident have to. However, six out of the six residents stated that they are not coerced, persuaded, or influenced to change pharmacy. Residents are informed and recommended to utilize any one of the three pharmacies (PH1, PH2, and PH3) facility works with. It was reported that out of the three pharmacies, residents are encouraged to utilize PH3. Per review of the resident roster obtained on today’s date, 46 residents reside at the facility. Out of the 46 residents, 24% of the residents utilize PH1, 20% with PH2, 32% with PH3, and 24% with various other pharmacies. Based on the evidence obtained, although 32% of the residents are using PH3, there are other pharmacies that residents are utilizing, therefore LPA is unable to corroborate the allegation. Regarding the allegation, Staff did not ensure resident’s medication was available at the facility, the investigation revealed the following: One out of the six residents and two out of three staff corroborated with the allegation during the interview stating that the PRN medication for Resident #1 (R1), Oxycodone and Acetaminophen, also known as Percocet, was not available at the time when it was needed. Per the doctor’s order for Percocet, R1 can take one tablet by mouth every 8 hours as needed. Based on the review of Narcotic Inventory Sheet from July 27, 2024, to September 25, 2024, the log documents R1 receiving Percocet on a daily basis three times per day. R1 received the last remaining tablet of Percocet at 2:48am on August 5, 2024. In a text message responded by Finance Manager (FM) Gabriel Airapetian, on August 5, 2024 at 5:57pm, the medication was being delivered by R1’s pharmacy. The inventory documents R1 receiving their second dose when the medication was delivered at 10:00pm that same day. Although R1 did not receive Percocet for close to 20 hours, it is determined based on the evidence obtained that the facility made an effort to ensuring that the medication was being delivered on time. Three out of the three staff confirmed that the delivery of medications can be delayed by R1’s pharmacy due to inventory issues. Therefore, based on the interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the following allegations: Staff require residents to purchase medications from a particular pharmacy and Staff did not ensure resident’s medication was available at the facility is deemed UNSUBSTANTIATED. Administrator Sona Hakobyan authorized LPA to conduct an exit interview with Finance Manager Gabriel Airapetian prior to her leave, and a copy of this report was provided at exit to Finance Manager Airapetian.the state’s words, verbatim · CDSS document, Oct 24, 2024 · control 22-AS-20240912115747

Allegation investigated: Staff sexually abuses the residents while in care Staff choked a resident while in care Staff behavior poses as a risk to the residents Staff is threatening a resident with eviction Staff are not meeting the residents dietary needs Staff are not providing the residents with proper utensils

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Administrator (AD) Sona Hakobyan and explained the reason for today’s inspection. The investigation into the allegations that staff sexually abuses the residents while in care, staff choked a resident while in care, staff behavior poses as a risk to the residents, staff is threatening a resident with eviction, staff are not meeting the residents dietary needs, and staff are not providing the residents with proper utensils revealed the following: During the course of the investigation, LPA inspected the facility, conducted health and safety checks on the residents, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, the facility’s menu since January 2024, and Staff #1’s (S1) training records CONTINUED Unsubstantiated Regarding the allegation that staff sexually abuses the residents while in care: it was alleged that S1 had inappropriate sexual incidents with multiple residents. LPA interviewed seven residents regarding this allegation, five of whom did not corroborate the allegation and had positive things to say about S1. Out of the seven residents interviewed, one resident had an issue in the past with S1, refused to disclose what the issue was, but stated that it had been addressed with AD and resolved properly and quickly. Per AD, this resident had requested that S1 no longer provide care for them but did not disclose the reason and AD stated it is not uncommon for residents to have preferences and requests with regards to which staff provide care. Out of the seven residents interviewed, another resident stated they had interactions with S1 that they felt were inappropriate, but the interactions were only verbal and based on the resident’s own description the resident themselves was a major participant in the interactions. In addition, LPA received information from another resident that the resident involved in these verbal interactions is not trustworthy. LPA interviewed AD who stated that they have not seen S1 engage in improper behavior as alleged. LPA interviewed S1 who denied the allegation. LPA did not obtain information corroborating this allegation. Regarding the allegation that staff choked a resident while in care: it was alleged that S1 choked a resident with a banana. LPA interviewed nine residents regarding this allegation, five of whom did not provide information about the allegation. One resident reported that S1 “shoved a banana” in their mouth, they were choking, and they do not know why S1 did this. Three residents corroborated this report, two of whom were direct witnesses. The two direct witnesses stated that, while the resident was in the dining room, the resident began coughing and gasping for air but was not choking, S1 tried to pat them on the back and then went to get a banana and tried to put the banana in the resident’s mouth against their will multiple times, and that they do not know why S1 did this. LPA interviewed AD who stated that they were informed of the incident by residents, they reviewed video footage of the incident, they observed S1 trying to assist the resident but did not see the banana, but they immediately suspended S1 pending investigation of the incident. LPA interviewed S1 who admitted the report, stating it was an emergency situation and they tried to put the banana in the resident’s mouth in order to help them because they believed eating something would help the resident clear their throat. LPA reviewed S1’s training records and confirmed S1 has current CPR, first aid, and caregiver training. While S1 acted improperly in this situation, the information obtained did not corroborate that S1 choked the resident. Regarding the allegation that staff behavior poses as a risk to the residents: it was alleged that S1 creates an unsafe environment for female residents by being sexually suggestive, flirty, and engaging in inappropriate touching and conversation. LPA interviewed seven residents regarding this allegation, five of whom did not corroborate the allegation and had positive things to say about S1. Out of the seven residents interviewed, one resident had an issue in the past with S1, refused to disclose what the issue was, but stated that it had been addressed with AD and resolved properly and quickly. Per AD, this resident had requested that S1 no longer provide care for them but did not disclose the reason and AD stated it is not uncommon for residents to have preferences and requests with regards to which staff provide care. Out of the seven residents interviewed, another resident stated they had interactions with S1 that they felt were inappropriate, but the interactions were only verbal and based on the resident’s own description the resident themselves was a major participant in the interactions. This resident also stated that S1 says “mi amor” to other residents, is “handsy” with other residents, and hugs and kisses other residents on the forehead. However, no other resident interviewed corroborated any improper behavior by S1. In addition, LPA received information from another resident that the resident involved in these verbal interactions is not trustworthy. LPA interviewed AD who stated that they have not seen S1 engage in improper behavior as alleged. LPA interviewed S1 who denied the allegation. The information obtained is conflicting. Regarding the allegation that staff is threatening a resident with eviction: it was alleged that residents are threatened with eviction for reporting issues at the facility. LPA interviewed seven residents regarding this allegation and did not obtain information corroborating the allegation. LPA interviewed AD who stated that there are no pending evictions. LPA did not obtain information corroborating this allegation. Regarding the allegation that staff are not meeting the residents dietary needs: it was alleged that there is no variety in the meals, Mexican food was served for almost all meals for months, the facility does not follow special diets such as vegetarian or diabetic diets, the daily vegetable is potatoes, and the alternative meal is always a sandwich with one slice of cheese or meat. LPA interviewed seven residents regarding this allegation and none of the residents reported major issues with the food or that they had a doctor-ordered diet that was not followed. One resident reported there is a lot of potatoes, pasta, and beans, while another reported the menu contains a lot of meat. One resident felt the facility serves a little too much Mexican food, while other residents disagreed. LPA inspected the facility, observed lunch to be chicken salad, fruit salad, and green salad which was provided by a catering company, observed residents enjoying the food, and did not observe any resident complaining about the food or asking for an alternative. LPA interviewed AD who stated that the facility follows all doctor-ordered diets and is working with the catering company to improve the variety of foods provided. LPA reviewed the facility’s menu since January 2024 which shows a proper variety of foods. The information obtained is conflicting. Regarding the allegation that staff are not providing the residents with proper utensils: it was alleged that residents are served food in takeout boxes and on Styrofoam plates due to the catering and lack of dishwashing staff. LPA inspected the facility and observed the facility has a sufficient supply of regular plates, bowls, cups, and utensils and that during lunch residents in the dining room were served with disposable plates and regular cups and utensils while residents eating in their rooms received disposable take-out boxes and disposable utensils. LPA interviewed AD who stated that in the morning the facility uses regular plates and utensils which are cleaned after breakfast by the cook and that for all other meals the facility may use regular or disposable plates and utensils depending on the day. LPA interviewed seven residents all of whom corroborated that the facility mainly disposable plates and utensils, but did not report that this has impacted their enjoyment of the food negatively, although one resident noted it is difficult to eat chicken with a plastic fork but another resident preferred the disposable plates and utensils as they are cleaner and lighter. Per AD, staff have already been advised to offer regular utensils for items that need to be cut, such as meat dishes, to ensure the use of disposable plates and utensils do not limit the residents’ enjoyment of the food. The information obtained is conflicting. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Aug 8, 2024 · control 22-AS-20240514210454

Type of visit: Case Management - Deficiencies

This unannounced Case Management – Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 22-AS-20240514210454. LPA met with Administrator (AD) Sona Hakobyan and explained the reason for today’s inspection. During the course of the investigation, LPA inspected the facility, conducted health and safety checks on the residents, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, and Staff #1’s (S1) training records. LPA interviewed nine residents regarding a report that S1 had choked a resident with a banana while in care, five of whom did not provide information about the report. One resident corroborated that S1 “shoved a banana” in their mouth, they were choking, and they do not know why S1 did this. Three residents corroborated the report, two of whom were direct witnesses. The two direct witnesses stated that, while the resident was in the dining room, the resident began coughing and gasping for air but was not choking, S1 tried to pat them on the back and then went to get a banana and tried to put the banana in the resident’s mouth against their will multiple times, and that they do not know why S1 did this. LPA interviewed AD who stated that they were informed of the incident by residents, they reviewed video footage of the incident, they observed S1 trying to assist the resident but did not see the banana, but they immediately suspended S1 pending investigation of the incident. LPA interviewed S1 who admitted the report, stating it was an emergency situation and they tried to put the banana in the resident’s mouth in order to help them because they believed eating something would help the resident clear their throat. LPA reviewed S1’s training records and confirmed S1 has current CPR, first aid, and caregiver training. However, the evidence obtained corroborated that S1 acted improperly in this situation and violated the resident’s personal rights. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Aug 8, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 9, 2024

87468.1 Personal Rights … (a) … (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews, the licensee did not ensure a resident was accorded dignity when S1 attempted to put a banana into a resident’s mouth against their will when they were having respiratory issues, which poses an immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 8, 2024

Plan of correction: Licensee stated that S1 has been terminated as of 05/20/24. During the inspection, LPA confirmed that S1 has been disassociated from the facility on Guardian. POC CLEARED.

Type of visit: Case Management - Other

This unannounced Case Management – Other inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering amended findings for Complaint Control No. 22-AS-20240514210454. LPA met with Administrator (AD) Sona Hakobyan and explained the reason for today’s inspection. During the inspection, LPA and AD reviewed and discussed the previously delivered report and the amended report and LPA delivered the amended report to AD. An exit interview was conducted and copies of this report and the amended report were discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Aug 8, 2024

Allegation investigated: Staff do not provide adequate food service

This is an amended report This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Sona Hakobyan and explained the reason for today’s inspection. The investigation into the allegation that staff do not provide adequate food service revealed the following: During the course of the investigation, LPA inspected the facility, conducted health and safety checks on the residents, interviewed AD and residents, and obtained and reviewed copies of the resident roster, staff roster, and the facility’s food service protocols. CONTINUED Substantiated Regarding the allegation that staff do not provide adequate food service: it was alleged that there are no dedicated meal servers, all caregivers are asked to serve food during meal times with no one covering caregiving duties, there is concern about cross-contamination of food since caregivers are putting on and removing gloves repeatedly as they juggle resident care needs and food service, the facility does not have a full time chef and the chef only supervises breakfast and snacks, and the facility uses catering for lunch and dinner. LPA interviewed seven residents regarding this allegation and did not obtain information corroborating the allegation. LPA interviewed AD who denied the allegation and stated that during meals there are two kitchen staff inside the kitchen plating food, two caregivers inside the dining room serving the residents, two caregivers making the rounds to provide care to residents along with a medication technician, and that staff do not switch between providing care and serving food in order to prevent cross-contamination. LPA inspected the facility and LPA’s observations did not corroborate the allegation. Regarding cross-contamination, LPA reviewed the facility’s food service protocols which contain the facility’s procedures for preventing cross-contamination which include the sanitation procedure to be followed if a staff member were to provide food service after providing care to residents. Per AD, staff are trained on the facility’s food service protocols and either an extra caregiver is assigned to work in the dining room and kitchen the entire day or the caregiver would start their day working in the dining room and kitchen and then switch to providing care afterwards. However, AD admitted that between March 30, 2024 and May 14, 2024, the facility did not have a full time chef as required. During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative. This is an amended reportthe state’s words, verbatim · CDSS document, May 23, 2024 · control 22-AS-20240514210454

From the deficiency page — Deficiency type: Type B

This page was amended due to this first citation being created in error.the state’s words, verbatim · CDSS document, May 23, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(17) · Plan of correction due date: May 24, 2024

87555 General Food Service Requirements (b) … (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service… This requirement was not met as evidenced by: Based on interviews, the licensee did not ensure the facility had a full-time chef for over a month, which poses a potential health risk to persons in care.the state’s words, verbatim · CDSS document, May 23, 2024

Plan of correction: The licensee has already hired a full-time chef and LPA confirmed. POC CLEARED

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Sona Hakobyan and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 10:00AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and medication room and observed the following: Structure: this is a large commercial facility. Facility is a 25-bedroom, 27-bathroom, 1 story building. There is a courtyard in the middle and a covered patio in the back with patio covers for the residents. Resident Bedrooms: the 7 resident bedrooms inspected are spacious and will easily accommodate the residents’ furnishings. Furniture for 7 resident bedrooms inspected. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested between 112 degrees F and 122 degrees in the 7 resident bathrooms inspected, prior to corrections. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed. Appliances: stove burners, microwave, washers, and dryers inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the housekeeping room. Medication room: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. The facility’s licensing fees have been paid. At about 11:00AM, LPA reviewed 7 resident files and 5 staff files, interviewed 5 residents and 5 staff, and inspected medications for 7 residents. Facility does not handle resident money. CONTINUED During the inspection, LPA and AD observed the following: based on documents, the facility does not have an Infection Control Plan; based on documents, the licensee did not ensure the files of S1, S2, S4, and S5 contained documentation of the required number of hours and topics of annual training; based on documents, the licensee's last emergency disaster drill was almost 4 months ago (not quarterly) and only involved 2 out of 3 shifts. A technical violation for water temperature was issued and the water heaters were adjusted down during the inspection. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Apr 30, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Facility is not providing adequate food service. Residents missed medications.

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced on a subsequent visit to continue the investigation and deliver the findings into the above allegations. LPA met with Administrator (Admin) Sona Hakobyan and stated the purpose of the visit. On February 23, 2024, LPA initiated the complaint investigation. LPA conducted the tour of the kitchen, observed one meal service at 12:09pm, interviewed five residents and four staff and obtained copies of pertinent documentation which includes: Resident Roster, Personnel Report, Resident Council Meeting Notes, February 18th-24th Menu, staffs' timesheets along with the residents' Face Sheets, Physician's Reports, and Medication Administratration Records (MARs). On today's visit, LPA interviewed three staff obtained additional documentation such as: Resident Roster, Snack Rounds Logs, Menu (highlighting the catering services), List of Diabetic Residents, Vital Signs Sheet, Communication Log, and the MARs for three residents. The investigation revealed the following: Substantiated It is alleged that the facility is not providing adequate food service. On February 23, 2024, at 12:00pm, LPA toured the kitchen and observed the following: There were ample two-day perishables and seven-day non-perishables food items in the refrigerator and pantry as required per regulation. LPA observed the lunch service from 12:09pm to 12:28pm and the facility is following the menu. Residents were having an open-faced turkey sandwich with gravy, mashed potatoes, green beans, and ice cream prepared by Staff #2 (S2). Food was hot, of portion, nutritionally balanced, and served on time. Based on the review of the Resident Council Meeting Notes dated February 7, 2023, it was noted that the residents requested frozen vegetables, easier to spread butter, and wanting more than one serving of juice. In addition, interviews revealed that two out of the five residents expressed concerns that food was cold, lacking variety and in quantity, and the food not being fresh when prepared by Staff #1 (S1). Five out of the five residents indicated that three meals are currently served daily with snacks in between and expressed satisfaction when meals are prepared by S2. Four out of the five staff also corroborated with the allegation when food was prepared by S1. It is alleged that the residents missed medications. Per review of the MARs for the month of February 2024, LPA observed that two out of the five residents did not receive their medications. Resident #1 (R1) was not administered Vitamin D2 for (2) days and Gabapentin was not administered for (27) days for Resident #2 (R2). Although interviews revealed that five out of the five residents and three out of the four staff did not corroborate with the allegation, the evidence obtained per record review revealed that the medications previously mentioned were not administered for two out of the five residents. Therefore, based on LPA's observations, interviews, and the records reviewed, the preponderance of evidence standard has been met, therefore the following allegations: Facility is not providing adequate food service and Residents missed medications are deemed SUBSTANTIATED as per the California Code of Regulations, Title 22, Division 6, Chapter 8. Two deficiencies are being cited on the attached LIC9099-D. An exit interview was conducted with Administrator Sona Hakobyan, and a copy of this report including the LIC9099-C, LIC9099-Ds, LIC811s, and the appeal rights were provided via email at the end of the visit.the state’s words, verbatim · CDSS document, Mar 8, 2024 · control 22-AS-20240222081433

From the deficiency page — Deficiency type: Type B · Section cited: CCR 97555(b))8) · Plan of correction due date: Mar 15, 2024

87555 General food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality. This requirement was not met as evidenced by: Based on interviews, facility did not provide adequate food service when food was prepared by S1 which poses a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: Adminstrator stated that they will submit an Acknowlegement of Understanding for the said deficiency to LPA via email by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Mar 11, 2024

87465 Incidental Medical and Dental Care (c)(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on observations and review of records, two out of the five residents did not receive one medication as prescribed during the month of February 2024 which poses an immediate Health risk to persons in care.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: Adminstrator to submit an Acknowledgement of Understanding for the said deficiency to LPA via email by POC due date and to conduct an in-service training covering the medication procedures and protocols including documentation and to provide a copy of the training form with the signatures of the attendees by March 15, 2024.

Allegation investigated: Staff failed to provide adequate food service Resident's hygiene needs are not being met

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation(s). LPA met with Administrator (AD) Sona Hakobyan and explained the reason for today’s inspection. The investigation into the allegations of staff failed to provide adequate food service and resident's hygiene needs are not being met revealed the following: During the course of the investigation, LPA inspected the facility, interviewed the former administrator and seven residents, and obtained and reviewed copies of the Resident Roster, Staff Roster, Photographs of the Facility, Menus, and the House Rules. Regarding the allegation that the staff failed to provide adequate food service: It was alleged that the facility did not have any ice and served warm water to residents, that the facility does not have a cook, and that every day the facility serves sandwiches and does not serve hot meals or provide snacks. Substantiated LPA interviewed the former administrator who denied that the ice machine was broken, but acknowledged the facility does sometimes run out of ice due to the large amount of ice used by the facility. LPA inspected the facility and confirmed that the ice machine did work, but found little ice in the machine. The former administrator stated that the facility has three cooks total and hired a new chef who is working on a new menu, but was unable to provide a copy of the recent menu for the month. Per the former administrator, the menu includes sandwiches, but also hot food as well as salads and vegetables. The facility provides three meals a day plus snacks, the snacks include fruit and sandwiches, residents are asked if they want snacks and there is also a sign advertising the snacks, and snacks are available at all times and the kitchen does not close. LPA interviewed seven residents, four of whom corroborated that the food is too often cold sandwiches or, if it is a hot food item, it is cold by the time they receive the food. Regarding the allegation that a resident's hygiene needs are not being met: It was alleged that a resident’s clothes and hands smell like cigarettes and that this resident’s hygiene needs are not being met as they rarely shower. LPA interviewed the former administrator who stated that some residents are independent, some need oversight, and some need care with showers. Residents that need showers get regular showers and that if the former administrator smells an odor, they will direct staff to provide a shower to the resident and/or clean the room as necessary. However, residents can refuse showers and all the facility can do is encourage them. The former administrator denied that any resident has regular hygiene issues and stated that rooms are regularly cleaned to prevent odors. One out of seven residents corroborated that their hygiene needs are not being met, stating that they have only received two showers in almost two months, that they request showers and get appointments for showers, but that staff never show up to provide the shower. LPA observed a strong odor coming from this resident and confirmed this resident’s hygiene needs are not being met. During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegations that staff failed to provide adequate food service and resident's hygiene needs are not being met. The preponderance of evidence standard has been met; therefore, the above allegations are Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative. LPA interviewed the former administrator who denied that the air conditioning was broken and stated that this was recently confirmed by a technician. LPA inspected six resident rooms as well as the kitchen, dining room, and common areas and observed the air conditioning was working and that these areas were at a comfortable temperature. The former administrator stated that smoking is only allowed in the smoking area per the house rules, that the facility has about 10 smokers, that some residents complain about the smell of smoke, but that the smokers always follow the house rules by smoking in the designated smoking area and the facility is looking into additional measures to address the concerns of other residents regarding the smell. LPA inspected the facility and observed the smell of cigarette smoke in the hallway closest to the designated smoking area when the door was open, but not in any resident rooms or common areas. LPA interviewed seven residents, none of whom corroborated that the air conditioning was broken. One out of seven residents complained about the smell of smoke, but that resident had left their window open to the designated smoking area. While some smoke smell enters the building when adjacent windows or doors are opened, residents are allowed to smoke and LPA obtained no information indicating residents are violating the house rules in regards to the designated smoking area or that the facility is otherwise uncomfortable. Regarding the allegation that the facility is in disrepair: It was alleged that a resident room flooded. LPA interviewed the former administrator who reported that two or three toilets were recently broken, but denied that there were any floods. LPA inspected the facility and did not observe anything broken or in disrepair. Six out of seven residents interviewed reported no issues with things being broken. One resident reported that their bathroom flooded, but that the facility promptly fixed it and cleaned the floor and the resident had no complaints about how the facility handled the repair. While a resident bathroom flooded, LPA received no information supporting the allegation that the facility is in disrepair as the issue was promptly and properly addressed. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegations that staff failed to provide a comfortable environment for residents and facility is in disrepair occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Dec 28, 2023 · control 22-AS-20220906103537

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Dec 29, 2023

87464 Basic Services … (f) Basic services shall at a minimum include: (1) Care and supervision... This requirement was not met as evidenced by: Based on observation and interviews, the licensee did not ensure 1 out of 7 residents received care and supervision when their hygiene needs were not met, which poses an immediate health risk to persons in care.the state’s words, verbatim · CDSS document, Dec 28, 2023

Plan of correction: The licensee stated that they have since initiated a shower log which documents whether showers were provided or refused in order to ensure residents are receiving their scheduled showers. During the inspection, LPA reviewed the shower log and confirmed the correction. POC CLEARED.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(5) · Plan of correction due date: Jan 11, 2024

87555 General Food Service Requirements … (b) … (5) Meals shall consist of an appropriate variety of foods and shall be planned with consideration for … food habits of residents. This requirement was not met as evidenced by: Based on interviews, the licensee did not ensure an appropriate variety of food when the food served was too often a sandwich or otherwise cold, which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 28, 2023

Plan of correction: The licensee stated the ice machine has been replaced and the menu has been redone and now contains mainly hot foods and few sandwiches. During the inspection, LPA confirmed these corrections. The licensee stated they will create a tray service protocol to ensure food is delivered still hot to residents who do not eat in the dining room and will submit proof to LPA by POC due date.

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.