California Dream Assisted Living

Type of visit: Required - 1 Year

At 12:15 PM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the staff Gayane Sahakyan and the Administrator was contacted via a telephone. LPA explained the reason for the visit. The Administrator Designee Rima Agaronyan arrived to the facility and conducted a physical plant tour of the facility with LPA. The Administrator arrived at 12:30. Kitchen: 12:20 AM, LPA toured the kitchen area. The kitchen contained two refrigerators with adequate supplies of staple non-perishable for minimum 1 week and perishable for 2 days. The laundry room is located next to the kitchen and LPA observed all detergents and cleaning supplies were locked and inaccessible to residents in care. LPA observed a fully charged fire extinguisher in the office area which located in the living room and was last purchased on 09/02/2025. Medications: At 12:25 PM, LPA observed a locked office where all residents medications were locked and inaccessible. LPA also observed residents and staff files locked and available for review. Bedrooms: The facility had five (5) bedrooms. One (1) bedroom is designated for staff. The staff bedroom was locked and contained no hazardous items. Bedroom #2 and bedroom #3 are shared and bedroom #1 and bedroom #4 are private. All bedrooms contained adequate storage space, clean linens, televisions, nightstands, and lamps. Bedroom #1, bedroom #2, and bedroom #3 had exit doors in the room with ramps leading out. Continue on LIC 809C Bathrooms: The facility had two (2) bathrooms. Both bathrooms contained fully stocked soap, paper towels, trash can, non-skid mats, and grab bars. LPA observed trash cans with tight fitting lids, -Hot water temperature measured at 118.9°F. Common Areas: The facility maintains a comfortable temperature at 77°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 12:30 PM they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational. Outside space: LPA observed a covered patio area for visitation and an extra table with furniture in good repair. All outdoor spaces and paths were from obstructions. Garage: LPA observed a garage with adequate incontinence supplies, PPE and two extra fridges. Between 12:45 PM to 1:45 PM, LPA reviewed records of four (4) residents and two (2) staff. Residents and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency cited during today’s visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 17, 2026

Type of visit: Required - 1 Year

At 9:30 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Administrator Designee Rima Agaronyan and explained the reason for the visit. Physical tour was conducted with the Administrator Designee and LPA observed the following: Kitchen: 9:40 AM, LPA toured the kitchen area. The kitchen contained two refrigerators with adequate supplies of staple non-perishable for minimum 1 week and perishable for 2 days. The laundry room is located next to the kitchen and LPA observed all detergents and cleaning supplies were locked and inaccessible to residents in care. LPA obsreved a fully charged fire extinguisher in the office area which located in the living room and was last purchased on 09/07/2024. Medications: At 9:45 AM, LPA observed a locked office where all residents medications were locked and inaccessible. LPA also observed residents and staff files locked and available for review. Bedrooms: The facility had five (5) bedrooms. One (1) bedroom is designated for staff. The staff bedroom was locked and contained no hazardous items. Bedroom #2 and bedroom #3 are shared and bedroom #1 and bedroom #4 are private. All bedrooms contained adequate storage space, clean linens, televisions, nightstands, and lamps. Bedroom #1, bedroom #2, and bedroom #3 had exit doors in the room with ramps leading out. Bathrooms: The facility had two (2) bathrooms. Both bathrooms contained fully stocked soap, paper towels, trash can, non-skid mats, and grab bars. LPA observed trash cans with tight fitting lids, -Hot water temperature measured at 117.3°F. Continue on LIC 809C Common Areas: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:22 AM they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational. Outside space: LPA observed a covered patio area for visitation and an extra table with furniture in good repair. All outdoor spaces and paths were from obstructions. Garage: LPA observed a garage with adequate incontinence supplies and PPE. Between 10:30 AM to 12:00 PM, LPA reviewed records of four (4) residents and two (2) staff. Residents and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency cited during today’s visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 4, 2025

Allegation investigated: Staff are not meeting resident's hygiene needs. Staff do not meeting resident's toileting needs.

At 09:15 AM, Licensing Program Analyst (LPA) Huma Rahimi, conducted an unannounced initial complaint visit. LPA met with Staff #1 (S1) who granted access to facility. The Designee was contacted and LPA explained the reason for the visit. During course of the investigation, interviews and record review were made. At 09:20 AM, LPA requested resident and staff roster. At 10:30 AM, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, etc., relevant to the investigation. At approximately 9:40 AM, LPA conducted a physical plant tour. Between 10:00 AM – 12:15 PM, LPA conducted an interview with the Designee, one (1) staff, four (4) out of four (4) residents, and Resident #1 (R1’s) family member. Continue on LIC 9099C Unsubstantiated Staff are not meeting resident's hygiene needs: It is being alleged that R1 did not receive a shower in about one week and a half (1½ ). To investigation this allegation, LPA conducted interviews with the Designee and one (1) staff, and both denied the allegation. LPA was informed that although R1 denies taking a shower occasionally, the facility still provides showers to R1 at least twice a week or as needed. Additionally, interview with R1’s family member confirmed the statement provided by the facility Designee and one (1) staff member. In addition, interviews with three (3) out of four (4) residents also revealed that they get showers at least twice a week. Moreover, during the interview with R1, LPA observed that R1 is well taken care of and appeared to be clean and well-groomed. There was no odor coming from R1. Based on interviews and LPA’s observation, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Staff do not meeting resident's toileting needs: It was alleged that staff left R1 on the toilet chair for an extended time which left R1 in pain. To investigate this allegation, LPA conducted an interview with S1 who denied the allegation. Staff informed LPA that they are always available to assist and check on R1 regularly while in the bathroom. Additionally, interview with the Designee revealed that R1 has a portable call button that R1 can carry everywhere and press for an assistance anytime. Once the call is activated, the staff provides an immediate assistance. LPA inspected the portable call button and observed it to be functional/operational. Lastly, interviews with three (3) out of four (4) residents confirmed that the facility staff always assist residents with incontinent and toileting needs and the residents are very pleased with the care provided. Moreover, interview with R1’s family member revealed that R1 takes extended period of time on the toilet chair due to the constipation and did not express any concerns regarding this allegation. Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.the state’s words, verbatim · CDSS document, Jun 18, 2024 · control 31-AS-20240611160853

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20240611160853. LPA met with Staff #1 (S1) who granted access to facility. The Administrator Designee was contacted and LPA explained the reason for the visit. During the visit, LPA was informed that on 03/30/2024, R1 had inflammation of the skin around the right foot toenails and R1 was taken to the hospital. On 04/29/2024, R1 was taken to the hospital again for the inflammation of the skin around the right foot toenails. Additionally, on 05/09/2024, R1 was taken to the hospital for the inflammation of the toenail not getting better and R1 being in pain. However, no incident reports were submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe any Incident Reports regarding R1. In addition, the Administrator admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPAs informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. LPA informed the Administrator to submit an incident reports that occurred on or before : 03/30/24, 04/29/2024, and 05/09/2024 (three incidents) Per the California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Jun 18, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a0(1)A,B&D · Plan of correction due date: Jun 18, 2024

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalization on or before 3/30/24, 2/29/24, and 5/9/24, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2024

Plan of correction: Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. R1's incident reports are provided at the time of the visit. POC cleared during the visit.

Type of visit: Required - 1 Year

At 10:55 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with Staff Lilit Egoyan, and later the Administrator Designee Rima Agaronyan, arrived at the facility and explained the reason for the visit. Physical tour was conducted with the Administrator Designee and LPA observed the following: Kitchen: 11:50 AM, LPA toured the kitchen area. The kitchen contained two fridges with adequate supplies of staple non-perishable for minimum 1 week and perishable for 2 days. Cabinets contained clean dishes, and adequate supplies of non-perishable food. At the end of the kitchen was a door to the laundry room. The room contained a washer and a dryer, and all detergents and cleaning supplies were in locked cabinets. Medications: At 12:05 PM Near the kitchen, LPA observed a locked office with resident medications, files, and water bottles. Bedrooms: The facility had five (5) bedrooms. One (1) bedroom is designated for staff. The staff bedroom was locked and contained no hazardous items. Two (2) resident bedrooms, Bedroom # two (2) and Bedroom #3 are shared. Two (2) resident bedrooms, Bedroom # one (1) and Bedroom # four (4) are private. All bedrooms contained adequate storage space, clean linens, televisions, nightstands, and lamps. Bedroom# one (1), Bedroom # two (2), and Bedroom # three (3) had exit doors in the room with ramps leading out. Bathrooms: The facility had two (2) bathrooms. Bathroom # one (1) is near the facility entrance and Bedroom # one (1). Bathroom # two (2) was between Bedroom # three (3) and Bedroom # four (4). Both bathrooms contained fully stocked soap, paper towels, trash can, non-skid mats, and grab bars. Hot water temperature measured at 117.3°F. Continue on LIC 809C Common Areas: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. LPA observed a fully charged fire extinguisher and purchased on 09/21/2023. Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 12:22 PM they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational. Outside space: LPA observed a covered patio area for visitation and an extra table with furniture in good repair. All outdoor spaces and paths were from obstructions. Garage: LPA observed a garage with adequate incontinence supplies and PPE. Between 12:30 PM to 2:30 PM, LPA reviewed records of five (5) residents and five (5) staff. Residents and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, and LIC500. No deficiency cited during today’s visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Mar 4, 2024