Buena Vista Villa RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian conducted an Annual Required visit and inspection of the facility. LPA met with Administrator - Michael Petrosian and explained the reason for the visit. The Residential Care Facility for the Elderly (RCFE) is licensed to serve (6) Non-Ambulatory clients with hospice waiver for three (3). Current census is six (6) and all clients are receiving services through Frank D. Lanterman Regional Center. At 11:20am, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed on the hallway wall. The smoke and carbon monoxide detectors are hardwired and interconnected. At 9:48am smoke/carbon monoxide detectors were tested and observed to function properly. The fire extinguisher is located in the kitchen and was purchased on 01/15/2026. Facility conducts emergency drills quarterly, the last Fire Drill was conducted on 05/04/2026 and the last earthquake drill was conducted on 03/02/2026. There are two exits, one in the kitchen (with three stairs) and the other is located by the kitchen, with a ramp leading to the rear sliding door. Facility uses the rear sliding door as the emergency exit, leading to the back alley. Common Areas: Living room is located by the entry door and leads to the dining room. Common areas were checked for cleanliness. There is a television set and cabinets containing games and art supplies in the living room. There is also a non-functional, screened fireplace in the living room. The furniture was observed to be clean and in good repair and included a dining table, coffee table, couches/chairs, sufficient for the capacity of the facility. Kitchen: The kitchen appliances and work surfaces are clean and sanitary. Facility has sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility. Knives were stored in a locked drawer in the kitchen and a water filtering system was observed underneath the sink. Bedrooms: There are three (03) shared bedrooms designated for clients' use. Bedrooms # 2 and #3 are next to each other and bedroom #1 is near the kitchen. The bedrooms were observed to be clean and clear of clutter, properly furnished with appropriate beds, night stands and chairs. Bathrooms: There are two (02) bathrooms designated for clients' use. Bathrooms had functional fixtures, grab bars and non-skid mats. The hot water temperature measured between 111 and 113.2 degrees Fahrenheit, within regulation. Surrounding Grounds: LPA observed that the entry/exits were free of obstruction. There is a covered area, for residents to use and furniture appropriate for outdoor use. The backyard is sufficient in space for outdoor exercise and activities. The facility has a detached garage, in the back, which is kept locked. The washer and dryer, cleaning products, kitchen detergents and chemicals are kept in the locked garage. LPA observed emergency food, water and an extra refrigerator, in the garage, to store an over flow of food for residents. Client/Staff Records: All records were kept locked in the office, which is located across the entry door. Six (06) out of six (06) client records were reviewed and observed to be complete and up-to-date physician records. P&I for all six (6) clients were counted and compared to receipts. Staff records for four (4) staff members were reviewed for compliance and current training and first aid/CPR certification. Medications: Two complete first aid kits, first aid manual and all medications are kept locked in a hallway closet. Medications for three (3) out of six (6) clients were counted and compared to Medication Administration Records (MAR) for accuracy of administration, based on physician orders. Operational Requirements: Liability Insurance was reviewed with expiration date of 06/12/2026, in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. Surety Bond was reviewed with expiration date of 11/12/2026, approved in the amount of $10,000.00. Administrator Certificate expiration date is 08/10/2027. Infection Control Plan and Emergency and Disaster Plan was also reviewed. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted / A Copy of the Report provided.the state’s words, verbatim · CDSS document, May 14, 2026

Type of visit: Required - 1 Year

On 06/16/2025 Licensing Program Analyst (LPA) Evelin Rios, arrived to the facility listed above to conducted an unannounced annual visit. Upon arrival LPA was greeted and granted access by staff. Staff contacted the administrator and informed them LPA was at the facility. In the facility LPA observed (03) three staff and three (03) residents. LPA met with the house manager, Mikayel Gurokyan shortly after. LPA explained the reason for the visit. This is a Residential Care Facility for the Elderly vendored by Lanterman Regional Center. At approximately 10:20 a.m, LPA conducted a physical plant tour of the facility and observed the following: At entrance on the first hallway leading to residents' bedrooms, LPA observed appropriate postings such as personal rights, the facility's Emergency Disaster Plan and facility sketch. Common Areas: These include the living and dining area. Common areas were checked for cleanliness and condition. The living room and dining area were observed clean and clear of clutter. The facility maintains a comfortable temperature at 72°F. LPA did not observe any tripping hazards. The furniture was observed clean an in good repair. Seating was sufficient for the capacity of the facility. Bedrooms: LPA observed a total of three (03) bedrooms designated for residents' use. Resident bedrooms are shared. Resident bedrooms were observed clean and clear of clutter, properly furnished with appropriate beds, night stands and chairs. LPA observed sufficient storage for residents. (continued on LIC 809-C) Bathrooms: There are two (02) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. At 10:47 a.m., LPA took the hot water temperature from one (01) out of two (02) bathrooms and it measured 114 degrees Fahrenheit, within regulation. Outside/Surrounding Grounds: LPA observed that the entry/exits were free of obstruction. There is a shaded area for residents to use and furniture appropriate for outdoor use. The backyard is sufficient in space for outdoor exercise and activities. The facility has a detach garage. In the garage LPA observed a washer and dryer. LPA also observed cleaning products, detergent, emergency food and an extra refrigerator to store an over flow of food for residents. Food Service/Kitchen: In the kitchen LPA observed the kitchen to be clean and clear of clutter. Appliances and fixtures were functional. LPA also observed a 7 day supply of non-perishable amount of food and a 2 day supply amount of perishable food in the facility, properly stored. Dual smoke/carbon monoxide detector are hardwired and interconnected, and were tested by the house manger at 10:48 a.m. and observed to be operational. There is a fire extinguisher in the facility located in the kitchen. Fire extinguisher was observed to be fully charged with purchase date 01/28/2025. Resident records: Six (06) of six (06) resident records were reviewed and observed to be complete and up-to-date. Medications: LPA observed medications were locked and kept in a hallway closet inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. Facility also keeps a Medication Administration Record (MAR). There is a complete first aid kit located in the medication closet. Staff records: Three (03) staff files were reviewed for compliance and current training. Staff records were observed complete and up-to-date. LPA reviewed facility records and observed the facility had an earth quake drill on 06/02/2025, fire drill on 05/01/2025 and last reviewed their Infection Control Plan on 04/02/2025. No deficiency cited during today’s visit. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Jun 16, 2025

Allegation investigated: Staff did not ensure that a resident had access to their ambulation device Staff yelled at a resident Staff did not ensure that the facility was maintained sanitary Staff did not ensure that the facility was maintained free of odor

On 08/05/24, at 9:50am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Caregiver, Haykuhi Dovlatyan. LPA disclosed the purpose of the visit. LPA explained the purpose of this visit was to gather information, conduct staff and resident interviews and deliver findings for this complaint. The Co-Administrator was called and arrived a few minutes later. The investigation consisted of the following: LPA Saucedo asked for the census, requested the staff and resident roster. At 10:20am, LPA toured the physical plant. During the tour, LPA interviewed two (2) residents and four (4) staff. 9099C-continued Unsubstantiated Regarding the allegation: Staff did not ensure that a resident had access to their ambulation device. It is being alleged that staff did not ensure that the resident's walker was in their room available for the resident to assist. Two (2) residents confirmed that their ambulation device is available for them in their room whenever they want to use it. Resident #1 (R1) stated that they have two (2) walkers. One (1) in their room and one (1) kept outside of their room which is used for outside recreation. Four (4) staff confirmed that the resident's ambulation device is always with them. During the physical tour, LPA observed that R1 had two (2) ambulation devices. One (1) was kept in their room and one (1) directly outside of their room for outside access. LPA also observed another resident (Resident #3) to have their ambulation device/wheelchair in their room. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time. Regarding the allegation: Staff yelled at a resident. It is being alleged that a staff yelled at a resident because a door became stuck. Two (2) residents confirmed staff do not yell at them. Four (4) staff confirmed that they do not yell at the residents, and it would not be allowed. During the physical tour, LPA did not observe any of the staff yelling at the residents. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time. Regarding the allegation: Staff did not ensure that the facility was maintained sanitary. It is being alleged that there was feces on one (1) of the bathroom walls. Two (2) residents confirmed that the facility is maintained sanitary and have never seen feces on the wall. Four (4) staff confirmed that they constantly clean throughout the day. During the physical tour, LPA observed staff cleaning. Furthermore, LPA observed two (2) bathrooms which did not have any feces on the walls. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time. Regarding the allegation: Staff did not ensure that the facility was maintained free of odor. It is being alleged that one (1) of the bathroom’s smelled like urine. Two (2) residents confirmed that the facility is maintained free of odor. Four (4) staff confirmed that they constantly clean throughout the day; thus, ensuring there is no odor. During the physical tour, LPA observed the facility free of odor. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) is UNSUBSTANTIATED at this time. An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Co-Administrator.the state’s words, verbatim · CDSS document, Aug 5, 2024 · control 31-AS-20240801131144

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met with Administrator Michael Petrosyan for a one (1) year required visit for this facility. Purpose of the visit was stated. This is a Lanterman Regional Center vendored facility level 4D. There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. A tour of the physical plant was conducted with the Administrator at 12:45 PM. The facility has three (3) bedrooms and two (2) bathrooms currently occupying five (5) residents. The facility is fire cleared for six (6) non-ambulatory residents. Hospice waiver for three (3) residents. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 72°F. Dual smoke/carbon monoxide detector is hardwired and interconnected, tested and observed to be operational. There is a fire extinguisher in the facility located in the kitchen. Fire extinguisher was observed to be full and last inspected on 02/06/24. (continued on LIC 809-C) The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. The garage is detached to the home. It is currently being used as storage for PPE, frozen foods, tools and old equipment. It is also being used as a Laundry area. The garage is observed to be locked and inaccessible to residents. Laundry detergents, cleaning solutions and other chemicals and toxins are locked and secured in the cabinet in the garage. 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. Dishwashing liquids and other cleaning supplies were stored in the locked in garage. All sharps and knives were also observed to be locked in a kitchen drawer. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hall ways/passage ways are lit to non-private rooms. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at 107.7°F to 112.6°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the cabinet. Medications: LPA observed medication were kept in the medication cabinet along the bedroom hallway and observed to be locked and inaccessible to residents. Medications are listed on the centrally stored medication and destruction record. There is a complete first aid kit located in the bedroom hallway. Client records: Client records are reviewed and appeared to be complete and updated. Staff records: LPA also conducted a complete file review of staff records. Staff record appeared to be complete and updated. Disaster drill was last conducted on 05/01/24. Required posting are observed to be complete and current and displayed properly at the facility. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, May 19, 2024