Burbank Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Administrator Serop Sarkisyan and Coadministrator Gayane Vardanyan explained the reason for the visit. The Residential Care Facility for the Elderly (RCFE) is approved for six (6) non-ambulatory residents with hospice waiver for three (3) residents. This facility is vendorized by Frank Lanterman Regional Center. Physical tour was conducted with the Co-Administrator at approximately 10:20am and LPA observed the following: The required posting were observed by the entry door and office area. The smoke/carbon monoxide detectors are dual, hardwired and interconnected. At 10:35am smoke/carbon monoxide detectors were tested and observed to be functional. There is a fully charged fire extinguisher located in the kitchen, purchased today on 06/08/26. Facility conducts monthly emergency and disaster drills. The last earthquake drill was conducted on 06/02/26 and the last fire drill was conducted on 05/02/26. COMMON AREAS: The facility has an open concept living and dining area, accessed at the front door. Living/dining areas are furnished with couches, dining table/chairs, two massage chairs and television. Facility has land line telephone, internet and wi-fi access for resident's use. The living area has a ramp, leading to a hallway with an exit. Facility uses the hallway exit as the emergency exit but there is another exit door in the kitchen with two side gates at the front. KITCHEN: Appliances and work surfaces are clean and sanitary. LPA found a sufficient amount of perishable (2 days) and non-perishable (7 days) food, properly stored in cabinets and refrigerator. There is a water filtering system, underneath the kitchen sink. Knives were stored in a locked drawer in the kitchen. Washing machine and dryer are located in the kitchen; all kitchen detergents and laundry chemicals were stored locked in a kitchen cabinet. Continued on 809-C BEDROOMS/BATHROOMS: There are six (6) private bedrooms designated for residents' use. Bedrooms were observed to be properly furnished with chairs, beddings and linens with sufficient lighting. There are two (2) bathrooms designated for residents' use. Bathrooms had functional fixtures and non-skid mats. Hot water temperature was measured between 113.4 and 119.3 degrees Fahrenheit. OFFICE/MEDICAL AREA: Facility's office area is located on one corner of the dining area but all records are kept locked in the medication cabinet in the hallway. LPA counted the medications for five (5) residents and compared to Medication Administration Records (MAR) for accuracy of administration. Currently one of the residents is in a rehabilitation center due to a scheduled surgery and resident's medication was sent with them. LPA observed a complete first aid kit and first aid manual in the medication cabinet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home is free of obstruction and hazards. The facility has outdoor covered patio with furniture including tables, chairs and umbrella. The facility does not have a swimming pool or any other bodies of water. The attached garage is located at the front and is currently used to store emergency water and supplies. RESIDENT FILES: LPA conducted a file review of all six (6) resident records to insure compliance of licensing forms. All physician records and assessments were current and reports are complete. P&I for four (4) residents were counted and compared to receipts. Two (2) of the residents' P&I are handled by their family, therefore LPA was unable to count the P&I. STAFF FILES: LPA also conducted a file review of four (4) staff records to insure forms and training are up to date and records are in compliance with licensing forms. REQUIRED REPORTS/DOCUMENTS: LPA reviewed the facility's Infection Control Plan, Emergency and Disaster Plan. Surety Bond expires on 02/20/27 and Liability Insurance expires on 05/09/27. Administrator Certificate expires on 05/12/27. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report provided.the state’s words, verbatim · CDSS document, Jun 8, 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 the administrator, Serop Sarkisyan. LPA explained the reason for the visit. In the facility LPA observed six (06) residents and four (04) staff. This is a Residential Care Facility for the Elderly vendored by Lanterman Regional Center. At approximately 1:33 p.m., LPA conducted a physical plant tour of the facility and observed the following: At entrance by the office area LPA observed appropriate postings such as personal rights, the facility's Emergency Disaster Plan and Personnel Report (LIC 500). Common Areas: These include the living and dining area. The living room and dining area were observed clean and clear of clutter. The facility maintains a comfortable temperature at 76°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 six (06) bedrooms designated for residents' use. Resident bedrooms are private. Resident bedrooms were observed properly furnished with appropriate beds, night stands and chairs. LPA observed sufficient storage and lighting for residents. Bathrooms: There are two (02) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. At 1:55 p.m., LPA took the hot water temperature from one (01) out of two (02) bathrooms and it measured 108 degrees Fahrenheit, within regulation. (continued on LIC 809-C) Outside/Surrounding Grounds: LPA observed that the entry/exits were free of obstruction. There is a shaded area for residents to use. The backyard is sufficient in space for outdoor exercise and activities. LPA observed greenery that provides shade for the residents. The facility has a detach garage. Garage is not accessible to 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. Dual smoke/carbon monoxide detector are hardwired and interconnected, and were tested by the administrator at 1:58 p.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 05/19/2024. Staff records: At 2:12 p.m., LPA reviewed five (05) staff files 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 05/01/2025, fire drill on 06/01/2025 and last reviewed their Infection Control Plan on 03/01/2025. 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 cabinet inaccessible to residents. Facility also keeps a Medication Administration Record (MAR). MAR documents the medications being centrally stored. There is a complete first aid kit located in the medication cabinet. 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

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan, met with staff Ruzanna Amirbekyan for a one (1) year required visit for this facility. Staff called the administrator and designated Ms. Amirbekyan to sign the report. 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 Ms. Amirbekyan at 8:55 AM. The facility has six (6) bedrooms and two (2) bathrooms currently occupying four (4) residents. One (1) bathroom is designated for staff use only. 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 75°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 bought on 05/19/24. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. The garage is attached to the home but has no access from inside the house. It is currently being used as storage for PPE and old equipment. The garage is observed to be locked and inaccessible to residents. Laundry room is located adjacent to the kitchen. Laundry detergents, cleaning solutions and other chemicals and toxins are locked and secured in the 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. Dishwashing liquids and other cleaning supplies were stored in the locked overhead cabinet in the laundry area. 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 118.9°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 04/03/24. 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