Board and Care Ayc

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met administrator Knarik Babayan for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 12:22 PM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The facility has four (4) bedrooms and two (2) bathrooms currently occupying six (6) residents. One (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, (1) one (1) of which may be bedridden on room #4. Hospice waiver for five (5) residents. Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. Dual smoke/carbon monoxide alarms are hardwired and interconnected, tested and observed to be operational. Fire extinguisher is located in the kitchen and observed to be full and last bought on 11/10/25. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C) (continued on LIC 809-C) The garage is currently being used as frozen food, refrigerated medication and old equipment storage. The garage was locked during visit. Laundry room is located adjacent to the kitchen. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at 118.8°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet. Medications: LPA observed medication was kept in a locked kitchen cabinet. There were two (2) complete first aid kits located in the medication cabinet. Client records: Client records are reviewed. Client records appear to be complete and updated. Staff records: LPA conducted a complete file review of staff records, staff files observed to be complete and updated. Disaster drill was last conducted on 1101/25. Required posting observed in facility (complaint hot line poster, LTCO). There is no health and safety issue during this visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Dec 19, 2025

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff do not assist resident with obtaining medical care Staff do not assist resident with incontinence care Staff do not assist resident with bathing

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Knarik Babayan and explained the reason for the visit. LPA conducted a physical plant tour at 9:12 AM, requested copy of facility documents relevant to the investigation at 9:43 AM. Reviewed records between 10:00 AM to 11:00 AM and interviewed residents between 11:00 AM to 1:00 PM. Regarding the allegation that Staff do not assist resident with obtaining medical care, it was alleged that staff did not arrange for Resident #1 (R1) skilled staff to come to the facility and provide R1 with the blood sugar monitoring training. LPA's record review today between 10:00 AM to 11:00 AM revealed that R1 was admitted with a Home Health agency who was supposed to care for all of R1's medical health needs. LPA's interview with the administrator today revealed that they did not assist R1 on glucose testing as R1 has own device provided by Home Health agency and R1 did not ask for assistance. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Further review also revealed that R1 was admitted at the facility on 03/07/25 and left on 04/05/25 on R1's own volition. Regarding the allegation that Staff do not assist resident with incontinence care, it was alleged that staff did not change R1's diapers during the night. LPA's record review of R1's physician's report (LIC 602) today revealed that R1 did not have bowel and bladder impairment. LPA's interview with staff however revealed that R1 was overweight and they had to assist R1 with incontinence care day and night. LPA's interview with three (3) incontinent residents today revealed that three (3) out of three (3) residents stated that they were always asked if they needed to change and change them regularly at least three (3) times (3x) during the day and once or twice (1x to 2x) at night. Regarding the allegation that Staff do not assist resident with bathing, it was alleged that staff do not assist R1 with bathing. LPA's interview with the Administrator today revealed that R1's home health agency has a bath lady coming for R1 but only came twice during R1's stay here for twenty (20) days. LPA's interview with staff today revealed that the staff offered to give R1 a shower but refused and stated that R1 would rather wait for the home health bath lady. LPA's interview with five (5) residents during this visit revealed that five (5) out of five (5) residents were given showers at least 2x a week as regularly as scheduled. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 9, 2025 · control 31-AS-20250402103719

Allegation investigated: Staff do not provide resident with toiletries Staff did not provide resident with a copy of admissions agreement

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Administrator Knarik Babayan and explained the reason for the visit. LPA conducted physical plant tour at 9:34 AM, requested copy of facility documents relevant to the investigation at 9:53 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:30 PM. Regarding the allegation that Staff did not provide resident with a copy of admissions agreement, it was alleged Resident #1 (R1) moved into the facility on 03/17/25 but did not receive a copy of admissions agreement until 4/1/2025. LPA's record review today at 10:00 AM revealed that the admission was signed on 03/15/25 or two (2) days prior to R1's admission by R1's financial responsible person (FRP). LPA's interview with the administrator today at 11:56 AM revealed that when FRP of R1 came and sign the admission agreement, the FRP left in a hurry and was not able to give a copy of the admission agreement but gave a copy of the agreement when they asked. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff do not provide resident with toiletries, LPA's observation today during physical plant tour revealed that the residents' bathroom have toiletries necessary provided by the facility. LPA's interview with three (3) aware staff between 11:00 AM to 1:30 PM revealed that three (3) out of three (3) aware residents stated that they were provided all the toiletries, including but not limited to towel, washcloth, toilet paper, paper towers etc., at all times. LPA attempted to interview two (2) other residents but they are either asleep during visit or on hospice and unable to talk. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 8, 2025 · control 31-AS-20250402103719

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met administrator Knarik Babayan for a One (1) Year Required visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 9:29 AM and the following was noted: There is only one entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The facility has four (4) bedrooms and two (2) bathrooms currently occupying five (5) residents. One (1) bathroom is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, (1) one (1) of which may be bedridden on room #4. Hospice waiver for five (5) residents. Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke detectors are hardwired and interconnected and observed to be operational. There are dual smoke/carbon monoxide installed at the facility. Fire extinguisher is located in the kitchen and observed to be full and last bought on 11/13/24. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C) (continued on LIC 809-C) The garage is currently being used as frozen food, refrigerated medication and old equipment storage. The garage was locked during visit. Laundry room is located adjacent to the kitchen. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathroom was checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at 118.7°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet. Medications: LPA observed medication was kept in a locked kitchen cabinet. There were two (2) complete first aid kits located in the medication cabinet. Client records: Client records are reviewed. Client records appear to be complete and updated. Staff records: LPA conducted a complete file review of staff records, two (2) out of three (3) staff reviewed did not have first aid training certificate on file. Disaster drill was last conducted on 1101/24. Required posting observed in facility (complaint hot line poster, LTCO). Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Nov 13, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Tan conducted an unannounced case management visit for a supposed complaint visit written against the facility. LPA found out in the middle of the visit that the complaint was written on the wrong facility and the complaint was deleted. LPA conducted physical plant tour at 9:02 AM and observed that the facility is clean and in proper order. LPA interviewed residents and revealed that the staff are good and respectful. There is no health and safety issue during this visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 21, 2024

Type of visit: Prelicensing

On 11.20.2023 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at facility at 9:45am conducted a pre-licensing inspection with the applicant representative and administrator. Knarik Babayan (licensee) and Anahit Ohanyan (administrator) was greeted upon entering the facility. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on July 25, 2023. A fire clearance was approved on September 13, 2023 for five (5) non-ambulatory residents and one (1) bedridden resident, for a total capacity of six (6). The applicant is also requesting a hospice waiver to retain five (5) residents. The smoke alarms and carbon monoxide detector are hard wired and inter-connected. The facility has one new fire extinguishers that was purchased on August 20, 2023. One fire extinguisher is located in between the dining room and the kitchen area. A tour of the physical plant was initiated at approximately 9:50am and the following was observed: KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, microwave oven and sink. The hot water delivered is measured at 118.9 degrees F. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). LPA inspected the kitchen and observed gas stove and refrigerator to be clean and working. Knives and sharps are stored in a locked kitchen drawer. Cleaning agents are also stored under the sink with a locking mechanism. BEDROOMS: There are four (4) bedrooms designated for client use in the hallway. Bedroom #1 and #2 are cleared to be private rooms. Bedrooms #3 and #4 will be used as a shared bedroom, where bedroom #4 will have the bedridden resident, a fire clearance (per STD 850) was cleared and given. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding, and linen. The bedrooms have sufficient lighting and closet space. The linens were stored in the storage space in each residents bedrooms. Continue to LIC 809-C BATHROOMS: The facility has two (2) bathrooms. Staff has their own bathroom with shower and tub for staff. The other bathroom is located by the end of the hallway, in between bedrooms #3 and #4. The bathroom were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 116.1 degrees Fahrenheit. COMMON AREAS: The common areas were appropriately furnished these included the living and dining room area. The living room was equipped with couch, non-audible camera, a television, tables and chairs. The LPA observed entertainment equipment and games for activities. The dining table is large enough to seat six (6) individuals. There is no fireplace in the facility. The facility has maintained a temperature of 70 degrees Fahrenheit. There were no visible immediate hazards. The facility has adequate linen, water, and emergency kits. LAUNDRY ROOM: The laundry room is located in the kitchen. It was observed with a locked door to make it inaccessible to the residents. The washer and dryer are brand new. All chemicals were stored and locked in the laundry room. MEDICATIONS: The medications will be located in the kitchen. It has a locking mechanism. OFFICE/STAFF WORKSTATION: The facility has a staff workstation that is in between the kitchen and the living room where designated storage cabinet for residents and staff records are located in a lock cabinet. The first-aid kit is complete. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensee. CAB will be advised, and a copy of this report provided. No health and safety hazard were noted during this visit. Licensee shall contact LPA once the first resident is admitted. Exit interview was conducted and a copy of report was issued. In addition to the pre-licensing inspection, a Component III power point presentation was also held.the state’s words, verbatim · CDSS document, Nov 20, 2023