Breath of Sunshine Harmony

Allegation investigated: Staff unlawfully evicted a resident. Staff is interfering with a resident's medical decisions.

Licensing Program Analyst (LPA) Evelin Rios arrived to this facility to conduct and unannounced complaint visit. LPA was greeted by Staff # 1(S1) who contacted the licensee, Armen Simonian and administrator Ruzzana Simonian. LPA met with the Licensee and administrator shortly after and explained the reason for the visit. In the facility there were two (2) residents having breakfast and one (1) staff providing assistance. The investigation consisted of the following: A physical plant tour was conducted to ensure the health and safety of residnets in care. LPA did not observe any health or safety concerns or issues. From 9:20 a.m. to 11:10 a.m., LPA attempted to interview two (2) out of two (2) residents, Resident #2(R2) and Resident #3 (R3). One (1) resident did not respond to LPA's questions and the other did not provide responses related to the complaint. LPA attempted to interview S1 but they preferred LPA direct questions to the administrator. LPA interviewed the administrator and the licensee. (Continue to LIC9099-C) Substantiated (Continued from LIC9099) LPA requested and obtained copies of the following documents: Register of Facility Residents (LIC 9020), Personnel Report (LIC 500), Resident #1's (R1's) admission agreement, Physician's Report (LIC602), Appraisal Needs and Services, Hospice documentation, 30 day eviction notice, and Unusual Incident Reports regarding R1. LPA Rios also interviewed R1's responsible party. LPA obtained copies of R1's after summary visit and wound consult from their time in the hospital. The investigation revealed the following: Regarding the allegation: Staff unlawfully evicted a resident. It was alleged that R1 was not permitted to return to the facility after being cleared for discharge. Instead, the facility issued R1's responsible party a 30 day notice. LPA's review of the 30 day notice provided to R1's responsible party dated 3/11/2026 revealed it is not in compliance with Title 22, Division 6, Chapter 8, Article 4, Subsection 87224 Eviction Procedures. The eviction notice is missing information about resources available to assist in identifying alternative housing and care options, a statement informing residents of their right to file a complaint with the licensing agency, and the an exact statement as specified in Health and Safety Code Section 1569.683(a)(4). LPA's interview with the administrator revealed that the purpose of issuing the notice was to document the actions of R1’s responsible party related to the incident on 03/10/2026, and to inform the responsible party of the conditions that must be met before R1 could be readmitted so that facility may be in compliance with regulations. The facility may have provided a separate notice regrading their conditions for readmittance or conducted a re appraisal to update R1's care plan so that the facility may determine whether they would be able to meet R1's needs or not. Instead the facility provided a 30 day notice for breaking house rules. Based on LPAs observations, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. (Continue to LIC9099-C) Page 2 of 3 (Continued from LIC9099) LPA requested and obtained copies of the following documents: Register of Facility Residents (LIC 9020), Personnel Report (LIC 500), Resident #1's (R1's) admission agreement, Physician's Report (LIC602), Appraisal Needs and Services, Hospice documentation, 30 day eviction notice, and Unusual Incident Reports regarding R1. LPA Rios also interviewed R1's responsible party. LPA obtained copies of R1's after summary visit and wound consult from their time in the hospital. The investigation revealed the following: Regarding the allegation: Staff threatened a resident. It was alleged that R1 was not permitted to return to the facility unless they had Hospice services. LPA's review of an eviction notice provided to R1's responsible party provided conditions for re admittance to the facility without hospice. LPA's interview with R1's responsible party confirmed the administrator stated R1 could return to the facility with Home Health services but then received a 30 day notice which to them meant R1 was ultimately not allowed to return. LPA's interview with the administrator revealed that the purpose of issuing the notice was to document the actions of R1’s responsible party related to the incident on 03/10/2026, and to inform the responsible party of the conditions that must be met before R1 could be readmitted so that facility may be in compliance with regulations. The administrator stated family decided to transfer R1 out and picked up R1's belongings. LPA was unable to find corroborating evidence that the administrator would not have allowed R1 back without Hospice services. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted. Copy of report provided to the administrator. Regarding the allegation: Staff is interfering with a resident's medical decisions. It was alleged that the facility would not allow R1’s responsible party to discharge R1 from hospice and would not provide a clear reason for R1’s hospice enrollment. LPA's interview with R1’s responsible party confirmed that they hold Power of Attorney for Health Care (POA), which LPA verified through documentation. According to the responsible party, when R1 was admitted, the administrator informed them that all residents admitted to the facility were on hospice. The responsible party acknowledged signing hospice paperwork but stated they were not provided copies when requested and were not given a clear explanation of R1’s hospice diagnosis. They reported that the administrator suggested R1’s wound might be the reason for hospice enrollment, which caused them to become concern. The responsible party further stated that they attempted to have R1 assessed by an outside physician due to concerns about the appropriateness of hospice services, but felt the facility discouraged this and insisted R1 remain on hospice. Which prompted them to contact emergency services to have R1's wound evaluated or taken to the hospital. R1's responsible party stated R1 is not terminally ill. LPA’s review of R1’s LIC 602 confirmed that R1 is not documented as receiving hospice services for a terminal illness. LPA's interview with the administrator revealed that the wound was identified at admission and that because a healthcare professional was required to oversee wound care they encourage R1's enrollment into hospice. The administrator acknowledged hospice enrollment would allow R1 to remain in the facility and the facility would be in compliance with Title 22, Division 6, Chapter 8, Article 11, Subsection 87633 Hospice Care of Terminally Ill Residents. The facility had the option to request a health condition exception or arrange for home health services to manage R1’s wound. Instead, the facility encouraged responsible party to enrolled R1 into hospice despite the absence of a terminal diagnosis and discouraged the responsible party from discontinuing hospice services so that R1 may remain in the facility. Based on LPAs observations, interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. An exit interview was conducted, California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D and a copy of this report was given to the administrator with the Appeal Rights. Page 3 of 3the state’s words, verbatim · CDSS document, Mar 17, 2026 · control 31-AS-20260312101942

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(d)(1)(B)-(D) · Plan of correction due date: Mar 18, 2026

Eviction Procedures (d)(1)The notice to quit shall include the following information: (B) Resources available... (C)... their right to file a complaint with the licensing agency... (D) ...statement as specified in Health and Safety Code Section 1569.683(a)(4)...This requirement is not met by: Based on the observations, interviews and record reviews, the licensee did not ensure 30 day eviction was in compliance with Title 22, which poses in immediate Health, Safety or Personal Rights risks to person in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: Licensee shall review eviction procedures and submit a statement of understanding to the department by POC due date 03/18/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(16) · Plan of correction due date: Mar 18, 2026

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. This requirement is not met by: Based on the observations, interviews and record reviews, the licensee did not ensure R1's POA for Health Care was permitted to make medical decisions regarding R1’s hospice services which poses in immediate Health, Safety or Personal Rights risks to person in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: Licensee shall review the subsections 87468.1 Personal Rights of Residents in All Facilities and 87633 Hospice Care of Terminally Ill Residents and provide a statement of understanding to the department by POC due date 03/18/2026.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Evelin Rios conducted a Case Management - Deficiencies visit in conjunction with the complaint control number 31-AS-20260312101942 investigation today. Upon entry to the facility, LPA observed one staff member, Staff #1 (S1) providing assistance with activities of daily living to residents. LPA requested the Personnel Report (LIC 500) from the Administrator, who provided a copy. The LIC500 did not list S1's name. LPA’s review of the facility’s roster in Guardian did not show S1's name. During LPA's interview with the Administrator they stated S1 was only at the facility for one to two hours while they went grocery shopping. LPA had observed S1 assist residents with transferring out of a chair and assisting them with ambulation to a recliner. Deficiency issued (refer to LIC809-D). Civil penalty assessed (refer to LIC 421BG). Appeals provided. Copy report issued.the state’s words, verbatim · CDSS document, Mar 17, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Mar 18, 2026

Criminal Record Clearance (e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility: 2)Obtain a California clearance or a criminal record exemption as required by the Department... This requirement was not met as evidence by: Based on interviews, and Guardian record review the licensee did not comply with the section cited above in having S1 working on 03/17/2026 without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2026

Plan of correction: The licensee agreed that the staff will not return until fingerprint clearance is completed and they are properly associated to the facility. Licensee will submit a statement on how they will follow the regulation moving forward by POC due date 03/18/2026.

Type of visit: Prelicensing

On Friday, 1/30/26, Licensing Program Analyst (LPA) Ray Comer conducted an announced Pre-Licensing visit and met with Administrator Ruzanna Simonian. Licensee is "BREATH OF SUNSHINE HARMONY INC". Fire Clearance granted on 12/07/25 for five (5) non-ambulatory residents, and an additional one (1) resident which may be bedridden in Room #3. Purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6. Facility is a single-story home, with a total of four (4) bedrooms; two (2) private, and two (2) shared. Facility has two (2) bathrooms. LPA tour of the physical plant was initiated at approximately 10:25 am, and the following was observed: KITCHEN - LPA observed kitchen appliances, (Refrigerator, stove, microwave, etc) working properly. Knives and sharps were stored in a lower kitchen drawer, locked and inaccessible to residents. Detergents and cleaning agents were stored in lower cabinet underneath the large sink and inaccessible to residents. FIRE SAFETY: Multiple dual smoke/carbon monoxide detectors are installed, hardwired, and interconnected throughout the facility. Smoke detectors were tested and were working properly. One (1) Fire extinguisher was observed in the kitchen, fully charged, which was purchased on 11/25/25. Evacuation routes are clearly labelled and posted. [LIC 809C]- Continued MEDICATIONS- Mediations will be stored in locked upper kitchen cabinet which was locked and inaccessible to residents. First aid kit was observed as fully stocked with required supplies. BEDROOMS – All bedrooms have sufficient lighting, and contained bed, linens, night stand, chest of drawers, chair, trash can with a lid, and closet space. BATHROOMS- All bathrooms contained hand soap, slip resistant floor mats, grab bars and a trash can. Water temperature was measured at 116 degrees F; within the required temperature range. LAUNDRY – Laundry room is located in attached garage. Detergents and other cleaning agents were on shelving above the washer/dryer machines. The laundry room was observed to be locked during visit. Multiple closets were observed in the facility containing fresh linens, blankets, and towels for residents. COMMONS: Consists of the living room, and the dining room area. Dining room was furnished with chairs and large table. Living room was furnished with a television, and a sofa with seating adequate for residents. Crafts and games are stored in kitchen cabinets. There were no visible immediate hazards. There is a working telephone line, and internet accessible to residents. OUTDOORS- Backyard area has a shaded area with a table and chairs sufficient for residents and staff. The driveway, passageways and entrance to the home were clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. GARAGE: Is attached to facility and was observed to be locked during visit. Garage is used for storage purposes. RECORDS- Staff and resident records will be stored in locking file cabinets located in a secured hallway closet and are inaccessible to residents. Component III was conducted with the applicant from 12:30 pm 1:00 pm. [LIC 809C]-Continued This report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview was conducted and a copy was provided to Administrator.the state’s words, verbatim · CDSS document, Jan 30, 2026