Blythe Senior Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:01 AM. LPA met with facility staff who contacted the facility Administrator Aram Muradyan. The Administrator arrived to the facility at 10:13 AM. Entrance interview was conducted and the reason for the visit was explained. Beginning at 10:14 AM the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: BEDROOMS: There are four (4) bedrooms in the facility; two (2) are dual occupancy resident rooms, two (2) are single occupancy resident rooms. LPA and the facility Administrator toured all four (4) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms #1 and 4 contained direct exits to the outdoors of the facility. LPA observed the auditory alarms in bedroom#1 and 4 to be non-functional at the time of the visit. LPA informed the Administrator who agreed to replace/repair the auditory alarms. OUTDOOR SPACE: The facility has one (1) emergency exit gate located on the side of the facility; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the outdoors of the facility to contain a properly secured swimming pool and a small fountain. LPA observed an appropriately secured washer/dryer room which contained the facility’s washer and dryer, cleaning chemicals, extra care supplies, a sink, and a toilet. LPA observed the outdoors of the facility to contain unsecured spray paint, lighter fluid, bug spray, and paint cans. LPA informed the Administrator who agreed to secure the items in a locked storage. Continued on LIC 809C. COMMON AREAS: This included the living room, hallway, and dining area. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a television, adequate seating, and an appropriately screened fireplace. The hallway was observed to be clean and free from any obstructions. The hallway contained closets that contained storage for linens and care supplies. LPA observed a hallway closet to contain an unsecured bottle of disinfectant spray. LPA informed the Administrator who immediately secured the bottle in appropriate storage. The dining area was observed to be equipped with adequate seating for resident use and contained locked storage for resident medications and files. LPA observed the dining area to contain a wall mounted fire extinguisher that was fully charged and purchased on 11/12/2024 which was more than twelve (12) months from the inspection date. LPA informed the Administrator who agreed to purchase a new fire extinguisher for the facility. The common areas contained all required postings. LPA observed RING cameras equipped with a microphone in the dining room and living room. LPA reviewed the admission agreements of facility residents which stated “Under no circumstances video surveillance will be permitted or utilized at Blythe assisted living.” LPA informed the Administrator that utilization of the cameras posed a personal rights risk to the clients due to the resident’s admission agreements and due to the auditory recording component of the cameras. The Administrator expressed understanding and removed the cameras from the facility at the time of the visit. The facility’s fire and carbon monoxide alarms were tested between 10:47 AM and 10:58 AM LPA observed three (3) fire alarms in the living room, dining area, and hallway that were not plugged in via hardwire or equipped with batteries. LPA informed the Administrator that fire alarms must be maintained in proper working order and not having the fire alarms in a function state poses an immediate safety risk to clients in care and violates the facility’s fire clearance. LPA informed the Administrator that this is a zero-tolerance violation and an immediate civil penalty of $500 is being assessed on today’s date (12/22/2025) for a violation of the facility’s fire clearance. The Administrator expressed understanding and immediately plugged the three (3) fire alarms into the hardwire. Additionally, the Administrator replaced the batteries in the three identified fire alarms at the time of the visit. Continued on LIC 809C. KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed an under-sink cabinet to contain cleaning chemicals and drawers to contain knives and other sharp objects. LPA observed these cabinets and drawers to be unsecured with no staff member working in the kitchen. LPA informed the Administrator who stated that staff had stepped out of the kitchen for a moment. LPA informed the Administrator that knives, sharp objects, and chemicals must remain secured if not in use by a staff member. The Administrator expressed understanding and secured the drawers/cabinet at the time of the visit. BATHROOMS: There are three (3) bathrooms at the facility. One is designated as a shared/common resident bathroom, one (1) is a private resident bathroom, and one (1) is a staff bathroom/laundry room. Both resident bathrooms were observed to be clean and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 117.0 and 118.2 degrees Fahrenheit, which is in compliance with regulation. RECORD REVIEW: Record review began at 11:05 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. three (3) staff files were reviewed. No staff files reviewed contained records of the initial forty (40) hours of training required prior to assisting residents. LPA requested to review a staff file for Staff #1 (S1) but was unable due to the file not being present at the facility. LPA reviewed the Administrator’s staff file which was observed to be missing the LIC 501, LIC 508, LIC 503, and proof of a negative TB test. Six (6) resident files were reviewed. Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3)’s files were observed to be missing signed copies of the resident’s personal rights. R1’s file was observed to be missing a copy of their admission agreement. R2’s file was observed to be missing a signed telecommunication device notification and R2 was identified by their physician to have an auditory impairment. Additionally, Resident #4 (R4), Resident #5 (R5), and Resident #6 (R6)’s files were observed to be missing proof of a negative Tuberculosis (TB) test. LPA informed the Administrator of the missing documents and that files must be maintained at the facility. The Administrator expressed understanding and agreed to complete all required documentation and trainings for staff and resident files. Continued on LIC 809C. MEDICATION REVIEW: Medication review began at approximately 01:00 PM. Medications for three (3) of six (6) residents were observed. All medications were stored properly. No medications observed were documented on their respective centrally stored medication and destruction record sheets (CSMDR). LPA informed the Administrator that a log of the medications that residents are taking must be accurate and maintained at the facility. LPA informed the Administrator that the log must include: the name of the resident for whom the medication is prescribed, the name of the prescribing physician, the drug name, strength and quantity, the date filled, the prescription number and the name of the issuing pharmacy, and instructions, if any, regarding control and custody of the medication. LPA informed the Administrator that for every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication in addition to the CSMDR. The Administrator expressed understanding and agreed to complete a CSMDR for all facility residents. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are to be conducted quarterly; LPA asked the Administrator when the facility’s last emergency disaster drill was conducted. The Administrator informed LPA that the facility had not yet conducted an emergency disaster drill. LPA informed the Administrator that a facility shall conduct a disaster drill at least quarterly for each shift. The Administrator expressed understanding and agreed to conduct a disaster drill. The facility’s emergency disaster plan is up to date and is adequate. Both the infection control plan and the emergency disaster plan were not reviewed/updated annually by the facility’s Administrator. LPA informed the Administrator who reviewed both plans at the time of the visit. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that staff treat them well and are quick to respond when asked. No residents had concerns with the facility. LPA interviewed two (2) staff members. One (1) staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. One (1) staff member interviewed was unable to appropriately identify the resident’s rights but was knowledgeable on their roles and responsibilities, the different forms of abuse, and the appropriate reporting procedures for suspected abuse. Continued on LIC 809C. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited and civil penalty assessed (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 22, 2025

The state marks this report as 14 pages; the online copy we transcribed has 13. You can request the full file from the county licensing office.

Allegation investigated: Staff did not ensure resident received wound care Staff are not ensuring resident has clean bedding Staff did not provide resident with a 60day notice to increase rent Staff did not ensure that there were not more than two residents in a room Food being served to residents is not of good quality

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint investigation visit at the facility at 10:01 AM. LPA met with facility Administrator Aram Muradyan entrance interview was conducted and the reason for the visit was explained. During today’s visit LPA conducted a physical plant tour, reviewed two (2) resident files, and conducted interviews with the Administrator, one (1) witness, and three (3) residents between 10:05 AM and 12:25 PM. Continued on LIC-9099C Unsubstantiated The allegation of “Staff did not ensure resident received wound care” alleges that the facility did not provide wound care for a wound on resident #1’s (R1) hand. LPA interviewed the Administrator who informed LPA that R1’s hand was in a cast after a fall that occurred before R1 was a resident of the facility. The Administrator denied R1 having any additional wounds. LPA reviewed R1’s file and hospital discharge paperwork. LPA did not observe any documentation of wounds that would require care. The Administrator stated that R1 wished to have the cast removed but R1’s physician required x-rays of the hand before an orthopedic doctor could remove the cast. LPA spoke with a representative from R1’s physician’s office witness #1 (W1) and was informed that R1’s family was provided referral orders for both the orthopedic doctor and x-rays. W1 confirmed that the referrals were provided to the family and not the facility. W1 stated that it was the family’s responsibility to set up the appointments and inform the facility of the time, date, and location of the appointments. W1 denied being aware of resident requiring care for any other wounds. The Administrator stated that they attempted to work with R1’s family to obtain a time, date, and location for the appointment but the family did not respond with the required information for the Administrator to assist with the appointments. The Administrator stated that R1 left the facility before the appointments for the x-rays and the orthopedic doctor could be made. No current residents interviewed reported having wounds that required care. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not ensure resident received wound care.” Therefore, the allegation is deemed Unsubstantiated at this time. Continued on LIC 9099C. The allegation of “Staff are not ensuring resident has clean bedding” alleges that the facility went extended periods of time without changing R1’s bedsheets. During the physical plant tour LPA observed six (6) resident beds throughout the facility. All bedsheets appeared to be clean. LPA interviewed three (3) residents. One (1) resident interviewed, resident #2 (R2), reported that bedsheets are changed at least once a week if not more often. One (1) resident interviewed, resident #3, (R3) reported that bedsheets are changed regularly. All residents interviewed denied not having their bedsheets changed for extended periods of time. LPA interviewed the Administrator who stated that they have cleaners that come to the facility every other day. The Administrator stated that the cleaner’s duties include changing the resident’s bedsheets and they are changed at minimum once a week. LPA observed the facility to be clean and well kept. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff are not ensuring resident has clean bedding.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff did not provide resident with a 60day notice to increase rent” alleges that the facility did not provide R1 with an appropriate 60-day notice of rent increase. LPA reviewed R1’s resident file. R1’s admission agreement dated 03/27/2025 revealed that R1 was to be charged $3500 for a shared room in the facility. During the interview with the Administrator, they informed LPA that R1 was initially being charged $2000 for a shared room due to special circumstances. The Administrator stated that R1 was supposed to be a short-term resident of the facility but when the time came for R1 to leave the facility R1 no longer wished to leave. The Administrator informed R1 that they would need to increase the rent of the bed to the amount agreed upon in the admission agreement. The Administrator stated that they provided a 60-day rent increase notice to R1 for the increase from $2000 to $3500 as agreed upon in the admission agreement. The Administrator provided LPA with a copy of the 60-day rental increase notice signed by both R1 and the Administrator dated 05/14/2025. The Administrator stated that the 60-day rental increase notice was to go into effect 60-days from the issuance of the notice but R1 voluntarily relocated from the facility on 05/29/2025 before the notice went into effect. The Administrator confirmed that R1 was never charged the $3500 amount for room rent as the notice had not yet gone into effect. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not provide resident with a 60day notice to increase rent.” Therefore, the allegation is deemed Unsubstantiated at this time. Continued on LIC 9099C. The allegation of “Staff did not ensure that there were not more than two residents in a room” alleges that the facility placed R1 into a room with two (2) other residents. During the physical plant tour LPA observed two (2) single occupancy rooms and two (2) dual occupancy room. LPA did not observe more than two (2) beds in any resident rooms. LPA interviewed three (3) residents. All three (3) residents denied having roommates. LPA interviewed the Administrator who denied having three (3) residents in any rooms. The Administrator stated that R1 was placed into a shared room while they resided at the facility. The Administrator stated that R1 was initially alone in the room but had a roommate move in while R1 was residing at the facility. The Administrator stated that R1’s roommate left the facility and no additional resident moved into the room until after R1 left the facility. During an interview with R1 they informed LPA Peraldi that they only had one (1) roommate during their stay at the facility. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff did not ensure that there were not more than two residents in a room.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Food being served to residents is not of good quality” alleges that the facility was not serving residents good quality food sufficient to meet their needs. During the physical plant tour LPA observed the facility’s refrigerator, freezer. And pantry. LPA observed a sufficient supply of two (2) days perishable and seven (7) days of non-perishable foods. LPA observed all foods to be stored in appropriately sealed containers. LPA did not observe any foods to be expired or stored in damaged containers. At approximately 01:15 PM LPA observed the facility’s lunch service to serve food of good quality and in sufficient amounts. LPA interviewed three (3) residents. All residents interviewed reported the food quality to be fine and reported that food is served in sufficient amounts. No residents interviewed had concerns with the quality or quantity of foods being served. LPA interviewed the Administrator who stated that R1 would request alternatives to the foods that were being served. The Administrator stated that on at least four (4) occasions they provided R1 with alternative foods from outside of the facility when they did not want what was being served. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Food being served to residents is not of good quality.” Therefore, the allegation is deemed Unsubstantiated at this time. A copy of the report was printed and exit interview was conducted.the state’s words, verbatim · CDSS document, Jun 6, 2025 · control 29-AS-20250602151751

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced case management deficiencies visit at the facility at 10:01 AM. LPA met with facility Administrator Aram Muradyan entrance interview was conducted and the reason for the visit was explained. During today’s visit LPA conducted a physical plant tour, reviewed two (2) resident files, and conducted interviews with the Administrator, one (1) witness, and three (3) residents between 10:05 AM and 12:25 PM. During the physical plant tour LPA observed resident #1’s (R1) bed to contain full-length bed rails. During the interview with R1 they reported that the full bed rails made them feel trapped as they were not able to leave the bed without asking for assistance from staff. LPA reviewed R1’s resident file. LPA did not observe R1 to be on hospice or R1’s file to contain a physician’s order for full bed rails. LPA interviewed the Administrator. The Administrator informed LPA that R1 was not on hospice and did not have an order for full bed rails. The Administrator stated that the bed rails were installed at the request of R1’s family as R1 is considered a fall risk. LPA informed the Administrator that full bed rails may only be utilized by residents who are receiving hospice care and have a hospice care plan that specifies the needs for full bed rails. LPA and the facility Administrator called the family member of R1, Witness #1 (W1) and explained this requirement. W1 confirmed that the rails were installed at their request. The Administrator agreed to remove the full bed rails at the time if the visit. The full bed tails were replaced with half bed rails located on the head half of the bed. Additionally, the Administrator stated that they would install a call button for R1 to utilize to notify staff if they require assistance getting out of bed. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 6, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Jun 6, 2025

87608 Postural Supports (a) ...Postural supports may be used under the following conditions. (5) ... (B) Bed rails that extend the entire length of the bed are prohibited except for... hospice care... This requirement is not met as evidenced by: Based on observation, interview, and file review the licensee did not comply with the section cited above as R1 was observed to have full bed rails without a hospice care plan and without a physician's orders which poses a potential personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Jun 6, 2025

Plan of correction: Administrator replaced the full bed rails with a half bed rail on the head half of R1's bed at the time of the visit. Administrator stated they would provide R1 with a call button to ask staff for assistance with getting out of bed. POC cleared during visit.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Aram Muradyan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested. The facility is one story. At 09:00 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents; and, one (1) bedridden resident. The facility has two (2) private resident bedrooms, Rooms # one (1) and three (3) and two (2) shared room(s), Room # two (2) and four (4). Rooms number three (3) and four (4) have direct exits to the outside. Bedroom # four (4) is designated as the bedridden approved room. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms awake night staff are required. All rooms were free of odors. All window screens were clean and maintained in good repair. There is one (1) bathroom in the hallway that is designated as a shared resident bathroom. Bedroom # three (3) has a private bathroom attached. Bathroom # three (3) is designated as a staff bathroom. The resident bathrooms have a shower/bathtub with non-skid materials. All toilets and showers have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Continued on LIC 809C. Resident and staff records are stored in a cabinet which is currently located in the dining room. Medications are centrally stored in a locked cabinet in the dining room. The first aid supplies were complete, including a thermometer and a current version of a first aid manual and are stored in a cabinet in the dining room. Kitchen knives are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents by the installation of child proofing devices. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at forty degrees Fahrenheit (40*F). The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored securely under the kitchen sink and in the laundry room which is inaccessible to residents in care. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and/or activity supplies in the living room. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight were made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is a fireplace in the living room. It is screened and there are no tools. Alarms on all but one (1) exterior doors (Bedroom #4) were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The smoke detector and carbon monoxide detectors were tested at 11:20 AM and functioned properly during the time of visit. There is one (1) fire extinguisher throughout the house. It is fully charged and does not exceed the expiration date. Continued on LIC 809C. Hot water was tested in each bathroom, which included the resident bathrooms and staff bathroom, in addition to the kitchen; and, the hot water ranged from 118.4 to 120 degrees Fahrenheit. The laundry area is located in a locked room attached to the facility. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in the resident bathrooms. Extra incontinence supplies are stored in the hallway closet and the laundry room. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted in all resident rooms and throughout the facility. The emergency telephone numbers are posted at the front entrance to the facility along with all other required postings. The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The entire property is fenced. The back and sides of the house are separated from the front yard by a gate located on the east side of the facility. The gate to the driveway is moved manually. There is a gate for persons to enter the front yard that did not self-latch at the time of the inspection. Additionally, the gate leading to the backyard of the facility was observed to not self-latch at the time of the inspection. There is a locked storage shed in the back yard that belongs to the landlord and is not associated with the facility. The facility is attached to an unassociated property that is inaccessible from the facility. There are two (2) bodies of water on the premises at the present time. One (1) fountain water feature that contains about 3-4 inches of running water and one (1) appropriately fenced off pool that is inaccessible to residents in care. There is no garage attached to the facility. The following items must be corrected prior to licensure. Submit proof of corrections, along with a copy of this report, to LPA Trevor Byrne so that your application may be completed. 87705 Care of Persons with Dementia (h) Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. 87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.the state’s words, verbatim · CDSS document, Dec 20, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Aram Muradyan, Applicant/Adminitrator Interview Method: Telephone interview On December 4, 2024 at 11:30 AM, Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant/Administrator. Copy of report sent via email and request to return sign copy to CAB by end of business day today.the state’s words, verbatim · CDSS document, Dec 4, 2024