Breath of Sunshine

Allegation investigated: Facility staff financially abused resident

At approximately 8:45 AM, Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit in response to the above-mentioned allegations. LPA met with Staff 1 (S1), who granted access to the facility. During investigation on 5.27.2025 at 10:30AM, LPA requested the resident and staff roster. Between 11:00 AM – 12:49 PM, LPA conducted an interview with the licensee, three (3) staff, and six (6) out of six (6) residents present at the facility. Between 12:50 PM and 1:15pm, LPA requested and reviewed copies of pertinent information, which included, but were not limited to Physician’s report, Admission Agreement, Power of Attorney (POA), and other documents relevant to the investigation. Allegation: Facility staff financially abused resident. Continue to LIC 9099-C Substantiated It was alleged that the licensee (S1) overcharged resident #1 (R1) responsible party for not picking up their belongings immediately upon death of resident. R1 passed away on 2.27.2025, and R1 belongings were not picked up until 3.10.2025. R1’s responsible party facility charged $1200 extra for 10 days. Interview with S1 revealed that they did not return the balance of $1200 that was requested by the POA because R1's belongings was not pick-up on time. After being interviewed by LPA, S1 then agreed to return the balance to R1's POA via Zelle. On 5.28.2025, LPA receive a call at 11:57 AM from R1’s POA that $1200 refund was received via Zelle from S1. Interview with residents revealed no issues with monthly dues. A review of R1's records revealed that POA was responsible for paying their rent. A review of R1's most recent invoice confirmed that R1’s POA paid their rent on 2.14.2025 for the month of February, which covers until mid-March 2025. Based on interviews and record review, the facility overcharged R1. Therefore, the allegation is deemed SUBSTANTIATED at this time. Exit interview conducted. Copy of the report provided. It was alleged that R1 bedroom smelled of cigarettes due to S1’s brother smoking close to the R1’s room. Interviews with facility staff revealed that no one smokes in the facility. No residents complain about any odor in the facility. LPA’s interview with five (5) out of six (6) residents revealed that they did not smell cigarette and they did not experience malodor in the facility. During LPA facility tour on 5.27.2025, there was no odor or cigarette butts observe in the facility, especially in R1 bedroom. Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview conducted. Copy of the report provided.the state’s words, verbatim · CDSS document, Nov 25, 2025 · control 31-AS-20250520140015

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2 · Plan of correction due date: Dec 9, 2025

Additional Personal Rights... (a) In addition...residents... have all of the following personal rights: (8) To be free from... financial exploitation. This requirement is not met as evidenced by: Based on interviews and record review, R1 was financially exploited by S1 which posed an immediate Health, Safety, or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: S1 will refund the balanced owed to R1’s POA.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff, Juleta Asryan, and explained the reason for the visit. Around 9:00 AM licensee Ruzanna Simonian arrived and was explained for the reason of the visit. At 10:31 AM, with the assistance of licensee, LPA took a tour of the physical plant. Required postings were observed in the entry area. At 11:00 AM smoke alarms were tested and are operational. There are carbon monoxide detectors that functions properly. The fire extinguisher is beside the kitchen. The charge date is 8/1/2025. During the visit the facility is at 76 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory of which one (01) may be bedridden in bedroom #4. Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Bedrooms: There were four (4) bedrooms designated for residents' use. Four (4) of the that are in use by clients were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Room #2 and #3 are properly furnished and is for private used. Room #1 and #4 is shared. Continue to LIC 809-C Bathrooms: There are two (2) bathrooms designated for residents' and staff use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 107.2 degrees Fahrenheit for bathroom #1 located in the hallway beside bedroom #3. Bathroom #2 measured 106.8 degrees Fahrenheit in room #1 bedroom. Cleaning supplies are being stored in a locked cabinet in the laundry room. Towels and washcloths are not shared. There was enough clean linen available in the cabinets in the hallway. Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Residents dining table fits enough for six (6). Office space is beside the living room. Properly labeled medications were locked in a drawer in the office station. Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area and detergents are located by the laundry room by the dining area and living room that are kept secured. The facility does not have a swimming pool or body of water. The garage is detached and is used for staff lounge. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records (MMR) were review for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit interview conducted and a copy of the report issued.the state’s words, verbatim · CDSS document, Aug 12, 2025

Type of visit: Case Management - Deficiencies

On 05/23/25 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda, conducted an unannounced case management visit. LPA met with the licensee and disclosed the reason for the visit. This case management visit was conducted in conjunction with complaint investigation #31-AS-20250520140015 to address deficiencies related to the complaint. Facility licensee did not submit an death reports or other required reports to the Licensing Division. During the initial complaint investigation, LPA conducted a facility records review and interviews with licensee revealed on 2.27.2025 for resident #1 (R1) death report. LPA asked and spoked with the licensee requesting an email or fax results that was sent to RO, but licensee could not provide the fax result/ email of R1 Death Reports to LPA. At the time of this visit, the licensee was informed reporting requirements and failed to follow Tittle 22 reporting requirements. Deficiencies are cited on the corresponding 809-D page. No immediate health or safety hazards were observed during today's visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, May 27, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(a) · Plan of correction due date: Jun 10, 2025

87211(a)(1)(a) Reporting Requirements-Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility...This requirement is not met as Based on LPA records review and interviews with licensee (S1) failed to submit R1 Death Report to licensing agency within seven days of the incident's occurance, which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, May 27, 2025

Plan of correction: Licensee has agreed to conduct an in-service training for all staff about the section cited. Licensee shall submit proof of training by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff, Marina Sarsyan and explained the reason for the visit. Approximately, around 1:40 PM designee Lily Balasantan and was explained for the reason of the visit. At 1:45 PM, with the assistance of designee, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 7/17/2024. During the visit the facility is at 73 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory of which one (01) may be bedridden; bedroom #4 approve for bedridden; hospice waiver for five (5). Kitchen: The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked drawer in the kitchen. Office space is in the living area beside the common area. Properly labeled medications were locked in the cabinets in the office station. Bedrooms: There were four (4) bedrooms designated for residents. Four (4) of the that are in use by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting. Room #1 and #4 are properly furnished are shared room. Bedroom #2 and bedroom #3 are private use and is currently vacant. Bathrooms: There are two (2) bathrooms designated for residents' and staff use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 109.8 degrees Fahrenheit for bathroom #1 located in the hallway across bedroom#3. Bathroom #2 measured 107.3 degrees Fahrenheit in bedroom #1. Towels and washcloths are not shared. There was enough clean linen available in the cabinets in the hallway. Continue to LIC 809-C Common Areas: These included the living room and dining area for residents. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Residents dining table fits enough for six (6). Surrounding Grounds: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area and detergents are located by the locked laundry room in between the dining room and living room that are kept secured. The facility does not have a swimming pool or body of water. The garage is detached and is used for storage for incontinence for residents. Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records (MMR) were review for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit interview conducted and a copy of the report issued.the state’s words, verbatim · CDSS document, Aug 20, 2024