Care of Heart

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Martha Arroyo and Angela Barutyan conducted an unannounced case management visit to ensure the health and safety of the residents in care. The LPAs were also accompanied by Adult Protective Services, Sona Shahumyan. Upon arrival, the LPAs and APS met with staff, Marina Martirosian and explained the reason for the visit. The Licensee Representative (LR), Alexander Otiashvilli was contacted telephonically at 9:35 a.m. with no reply. Entrance interview. On today's visit, the LPAs conducted a plant tour at 8:52 a.m. and checked in with the two remaining residents at the facility. Both residents stated that they had eaten breakfast earlier. Staff reported that the internet was no longer functioning, which prevented residents from watching television. The LPAs observed that sufficient quantities of both perishable and non-perishable food were available, along with emergency drinking water. A tour of the physical plant revealed no visible concerns. At 9:42 a.m., the LR contacted staff by phone, and the LPAs briefly spoke with him. The LPAs informed the LR that a 60-day written notice of intent to close the facility must be issued to all residents and their family members. Licensing Program Manager (LPM) Kristen Heffernan also spoke with the LR. At that time, the LR insisted that the facility be closed before the end of the month and confirmed his consent for the closure to proceed as soon as possible. During today’s visit, Resident #1 (R1) was relocated to a licensed facility and Resident #2 (R2) was transported to the hospital for further evaluation at approximately 6:05 p.m. Report Continued on LIC 809C... Report Continued from LIC 809... At approximately 6:10 p.m., the LPAs conducted a final walkthrough of the facility and confirmed that no care and supervision were being provided. Additionally, Marina Martirosian surrendered the facility license to the LPAs. After today, this facility is no longer licensed and shall not provide care and supervision to any residents or admit any new residents. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 28, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.682(a)(2)(A-F) · Plan of correction due date: Aug 28, 2025

(a) A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility to another facility or to an independent living arrangement as a result of the forfeiture of a license… (2) Provide each resident or the resident’s responsible person with a written notice no later than 60 days before the intended eviction…This requirement was not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above as the facility did not give 60 day notice of closure to residents, which poses an immediate health, safety or personal rights violation to persons in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: The facility will be closed effective 08/29/2025.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit to ensure the health and safety of the residents in care and met with Marina Martirosian, Staff. Alexander Otiashvilli, Licensee did not participate in this visit and was again unreachable via telephone. The reason for today's visit was explained. The home has a census of four residents. Resident #1 and Resident #2 are present at the facility and Resident #3 and Resident #4 are still hospitalized. A tour of the bedrooms was conducted and Resident #1 and Resident #2 were observed in bed watching television. Both indicated that they had breakfast. During the visit, Resident #2 was given a bath by home health personnel. Utilities - gas, electricity and water - were observed in use. Sufficient perishable and non-perishable foods were observed. Emergency drinking water was available. Per tour of the physical plant, there were no visually obvious concerns observed. On this visit, Marina Martirosian advised LPA Yee that she made the decision to close the facility since the Licensee was not cooperating or assisting her with the operations of the facility. She indicated that she was not able to operate the home alone. She would need assistance with relocating the residents. LPA Yee advised Marina, that we would need a written closure letter signed by the Licensee. She was also advised that a sixty(60) day notice needs to be given to each resident and responsible party and a relocation list provided to the Department with the name of the relocation site and contact information for verification of placement, once the residents have been relocated. A copy of Title 22, Chapter 8, Section 87224 Eviction continued on LIC809-C Procedures and Health and Safety Code, Chapter 03.2, Section 1569.682 Transfer of resident upon forfeiture of license or change in use of facility; duties of licensee; closure plan; duty of department upon licensee's failure to comply; civil penalties was provided to the staff for review. A sample Eviction Notice and Closure Letter was provided to staff to assist in drafting their eviction and closure letter. Staff will provide the letters to the Department once staff obtains the Licensee's signature.. Exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 25, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit to ensure the health and safety of the residents in care due to the unexplained absence of the Licensee. LPA Yee was let into the home by Marina Martirosian, Staff. Also present during this visit was Svetlana Martirosian, Family member. Alexander Otiashvili, Licensee was not available to conduct this visit. Staff was provided with the reason for today's visit. During today's visit, LPA Yee toured the bedrooms and spoke with Resident #1 and Resident #2 and both indicated that they were doing well. Both residents were having beef soup for lunch in their rooms. Resident #3 and Resident #4 are still hospitalized. Per tour of the physical plant, there weren't any visual concerns observed and the home was clean. Utilities - electricity, gas and water were observed in use during the visit. Per Marina, the facility's utility bills were paid and are current. The food supply was reviewed and there was sufficient perishable and non-perishable foods and drinking water observed in the kitchen. During this visit, LPA Yee also made multiple attempts to reach Alexander Otiashvili via telephone to discuss the facility's lack of an administrator as confirmed via contact with the prior Administrator. The Licensee also has a Administrator Certificate and no new Administrator documents have been submitted to the Department for review of his qualifications as of this visit. Basically, there is no oversight being provided for the daily operations of the facility. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, APPEALS RIGHTS were discussed and a copy was provided.the state’s words, verbatim · CDSS document, Aug 21, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(a) · Plan of correction due date: Aug 22, 2025

Administrator - Qualifications and Duties:All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section........Prior Administrator was terminated and as of this visit and prior visits, the facility does not have a qualified Administrator to operate the facilitythe state’s words, verbatim · CDSS document, Aug 21, 2025

Plan of correction: The Licensee will take immediate steps to hire a qualified Admininstrator to operate the facility or submit Administrator documents to appointment himself as the Administrator to the Department for review by 8/22/25.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced case management – health check visit to ensure the health and safety of the residents in care. Upon arrival, the LPA met with staff, Marina Martirosian and explained the reason for the visit. The LPA and staff attempted to contact the Licensee Representative (LR), Alexander Otiashvili during today’s visit with no response. Entrance interview. During today’s visit, the LPA conducted a tour of the facility inside and outside to ensure there were no immediate health or safety hazards. The LPA observed two residents, who reported they were doing well and had just finished breakfast. All utilities were observed to be on and functioning properly. The food supply was also observed and there is a sufficient amount of both perishable and non-perishable foods. The LPA also obtained copies of pertinent documentation. For some records that had not been recently updated, staff stated that the LR is responsible for maintaining and updating all residents’ documentation. Exit interview. A copy of the report was printed for staff and also emailed to LR.the state’s words, verbatim · CDSS document, Aug 19, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Christine Yee and Martha Arroyo conducted an unannounced joint case management visit to ensure the health and safety of the residents in care. LPA Yee and LPA Arroyo met with Marina Martirosian, Staff and the reason for the visit was provided. On today's visit, LPA Yee and LPA Arroyo had a discussion with Marina Martirosian about her decision to continue the operations of the facility during the unexplained absence of the Licensee and the failure of the Licensee to respond to the Department's multiple attempts to contact him. Per information received, staff wants to continue operating the facility but does not have the knowledge and wants to hire someone to run the facility. Marina indicated that she needed more time to make a decision. No firm decision has been made as of this visit. LPA Arroyo conducted a tour of the bedrooms to observe Resident #1 and Resident #2. The resident's were observed in bed watching television and were doing well. Resident #3 and Resident #4 are both hospitalized and it is unknown if they will be able to return any time soon. The 2 residents belongings are still at the facility. A tour of the physical plant, inside and outside, was also conducted and no visually obvious concerns were noted. Lunch was being prepared by staff and utilities - electricity, water and gas were observed in use during the visit. Food supply was reviewed and perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 seven days were observed. Emergency drinking water was also observed in the kitchen cabinets. continued on LIC809-C A conference call was also conducted with Marina Martirosian, Staff, Jill Nakata, Regional Manager, Kristin Heffernan, Licensing Program Manager, LPA Yee and LPA Arroyo to discuss the Department's concerns and to obtain any additional telephone numbers where the Licensee may be reached. During this visit, the following documents requested by the Audit Department were hand delivered to Marina Martirosian, staff to deliver to the Licensee to complete: Engagement Letter, LIC401 Monthly Operating Statement, LIC401a Supplemental Financial Information, LIC403 Balance Sheet and LIC403A Balance Sheet Supplemental Schedule. The forms need to be completed and returned by 8/18/25 Exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 14, 2025

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit to check on the health and safety of the residents in care and to ensure that there are no immediate concerns that need to be addressed. LPA Yee met with Marina Martirosian, Caregiver. Alexander Otiashvili, Licensee was not present during this visit and did not respond to the staff's text. The reason for today's visit was provided. During today's visit, LPA Yee conducted a tour of the resident rooms to observe the three residents present in the home. Resident #1 was observed sitting in an arm chair in their bedroom, Resident #2 and Resident #3 were observed in bed watching television. The residents all indicated that they have had lunch. Resident #4 is currently hospitalized and it is unclear if the resident will be returning to the home. Utilities and the air conditioner were observed to be in use. The food supply was reviewed and was sufficient for the three residents in care. Staff was advised to ensure that the facility maintains perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days for 6 residents on the premises at all times and not just for the 3 residents. Additional drinking water should be purchased. The water temperature was tested in the common bathroom and it read 123.7 degrees Fahrenheit. Per tour of the inside and outside areas, there were no visibly obvious hazards or concerns observed on today's visit. Also discussed on today's visit was the status of the general liability insurance. A certificate of insurance naming the Department as a certificate holder was requested. Per staff, the insurance agent will be sending the renewal on Monday - 8/4/25. Deficiencies cited under California Code of Regulation, Title 22, Division 6, Chapter 8. Civil Penalties were assessed for repeat violations. Exit interview was conducted and a copy of this reportthe state’s words, verbatim · CDSS document, Aug 1, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Aug 2, 2025

Maintenance and Operation:Water supplies and plumbing fixtures shall be maintained as follows: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). The water temperature tested in the common bathroom read 123.7 degrees Fahrenheit. Civil Penalties of $250 were assessed.the state’s words, verbatim · CDSS document, Aug 1, 2025

Plan of correction: The Licensee will adjust the thermostat on the water heater to ensure that the water used by residents attain a temperature of not less than 105 degrees F and not more than 120 degree F. License will provide evidence of a water temperature reading between 105 degrees F and not more than 120 degree F by 8/2/25

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced case management visit to discuss the opportunity for the facility to be referred to the Technical Support Program (TSP). Upon arrival, the LPA met with Licensee Representative, Alexander Otiashvili and at this time the reason for the visit was explained. Entrance interview conducted. During today’s visit, a physical plant tour was conducted to ensure there are no health and safety concerns. In addition, the LPA encouraged the Licensee Representative to consider participating in the TSP. This is a non-enforcement program offered by the Community Care Licensing Division (CCLD) that provides services and resources to assist providers in meeting licensing requirements. The TSP is designed to help facilities achieve and sustain compliance through training, support, and access to relevant tools. The LPA provided the Licensee Representative with the following contact information for TSP services. TSP email address TechnicalSupportProgram@dss.ca.gov and their phone number (916) 654-1549. The Licensee Representative agreed to contact TSP for further information and assistance. Additionally, the LPA also conducted a follow-up in reference to deficiencies that were cited during the annual continuation visit that occurred on 07/10/2025. The LPA and Licensee Representative reviewed previous citations and discussed plan of corrections. The Licensee Representative stated that they will work on the plan of corrections and agreed to email copies of pertinent documents to CCL no later than Monday 07/21/2025. Documents requested include but are not limited to; plan of corrections from 07/10/2025, resident admissions agreement and facility’s bank account information. Exit interview conducted. Report was reviewed and copy issued.the state’s words, verbatim · CDSS document, Jul 16, 2025

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPAs) Christine Yee and Martha Arroyo conducted an unannounced Annual Continuation Visit to the facility to continue the annual inspection visit initiated on 01/27/2025. Upon arrival, there was one (1) staff and four (4) residents present. The LPAs met with staff, Marina Martirosian, and explained the reason for the visit. The LPAs contacted the Licensee Representative, Alexander Otiashvili via telephone and were informed that they were unavailable to join in today’s visit. Entrance interview. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety concerns. The power has been restored to the facility as of 07/09/2025. No immediate safety concerns were observed during today’s inspection. The following was observed during the plant tour: KITCHEN: The LPAs inspected the kitchen/food service area. Knives and sharps were observed in a locked drawer at the time of the visit. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Staff stated they plan on going grocery shopping within the next few days. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed to be new with a purchase date of 01/26/2025. The LPAs observed required postings throughout the common space. RESTROOMS: There is one (1) restroom by the main hallway for resident use, which was clean and sanitary and in operating condition with grab bars and non-skid surfaces. Report Continued on LIC 809C... Report Continued from LIC 809... The bathroom was sufficiently stocked with supplies and paper towels. The hot water temperature was measured at 115.8 degrees Fahrenheit at 3:50pm. Personal hygiene items were observed locked and inaccessible under the bathroom sink at the time of the visit. BEDROOMS: There are three (3) total bedrooms in the facility; all bedrooms are designated for double occupancy. Resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. LAUNDRY ROOM: Washer and dryer were observed in a closet by the main hallway. The LPAs observed a closet with additional clean linens and towels for resident use. BACKYARD: The LPAs observed an adequate amount of emergency food and water. Laundry detergent and cleaning supplies were observed in a locked cabinet and a locked shed at the time of the visit. The backyard has a shaded patio area with adequate furniture for residents’ use. All passageways were observed to be clear. The LPAs observed two (2) self-latching gates. However, one (1) gate was observed locked at the time of the visit. Technical Violation issued to remove lock from gate. There were no bodies of water noted at the time of the visit. RECORDS: The LPAs reviewed resident records and staff records during today’s inspection. Four (4) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with negative TB results, preplacement appraisal, and appraisal / current needs and services plan. Per record review, 4 out of 4 residents did not have a preplacement appraisal on file, 3 out of 4 residents did not have a negative TB test result on file, 1 out of 4 residents did not have completed admissions agreement on file as it was missing signatures and dates from both resident and facility designee, and 2 out of 4 residents did not have a PRN authorization letter on file. Two (2) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. Report Continued on LIC 809C... Report Continued from LIC 809C... Per record review, there is no evidence that the Administrator meets the educational requirements per regulations, staff providing care had first aid/cpr certification expire on 06/17/2025 and has not renewed it as of today, and 1 out of 2 staff is missing the health screening with negative TB test results, MEDICATIONS: The LPAs conducted a medications review. Medications are centrally stored in a locked cabinet adjacent to the kitchen. Medications are being documented as they are received and appear to be administered as prescribed at the time of the visit. INFECTION CONTROL/EMERGENCY DISASTER PLANNING/PLAN OF OPERATION: During today’s visit, the LPAs reviewed the facility's infection control plan. The staff does not have proper use of PPE training on file. The LPAs also reviewed the facility's emergency disaster plan, which was observed to be complete; however, both the infection control plan and emergency disaster plan are not being reviewed/updated annually since June 2023. Additionally, the LPAs did not observe any training logs for emergency disaster drills being conducted quarterly as per regulation. The Plan of Operation was observed to be missing section on how the facility will address residents with behavioral expressions and limited liability insurance was confirmed to have been cancelled since 08/30/2024 due to non-payment. Interviews with staff also revealed that the fire department was not notified of oxygen use by residents. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit due to deficiencies observed on today's visit. LPA Yee met with Marina Martirosian, Staff. Also present at the facility was Svetlana Martirosian, staff's mother. She does not have a criminal record clearance. Multiple attempts were made via telephone to reach Alexander Otiashvili, Administrator/Licensee and all attempts were unsuccessful. The reason for the visit was explained. Upon arrival at the home to conduct the initial investigation for a complaint, LPA Yee was informed by staff that Alexander Otiashvili was not at the facility and they could not do anything without him. LPA Yee was asked to return another day. LPA Yee was then told that the facility did not have any electricity and has not had electricity since Saturday, July 5, 2025. The reason provided for the electricity outage is because the facility did not pay their electric bill and the power was shut off. A health and safety check was conducted. A tour of the facility was conducted to observe the 4 residents in care and to determine if there were any immediate issues to be addressed. Resident #1 was observed sitting on their bed and LPA was initially told that they did not feel the heat but later indicated that the room was hot. All the residents had pizza for lunch and cookie and ice cream for a snack. Resident #2 and Resident #3 were laying in bed with the use of their oxygen. Per both residents, they were okay and was not feeling the heat. Resident #4 was also observed laying in bed and was comfortable with the heat early in the visit but was later observed wiping perspiration from their forehead later in the afternoon, but was not observed distressed. The mattress was observed inflated. Staff was advised to ensure that the residents get lots of water and wet towels to cool them down. Per tour of the facility, an extension cord was observed coming in from the window into bedroom #3 from the the home of the neighbor to the right. Extension cords and electrical strips leading from bedroom #3 were observed in bedroom #2 and along the hallway to the kitchen. Resident #2 and Resident #3 oxygen tanks, Resident #4' inflatable mattress and the kitchen refrigerator were all hooked to the extension cords and electrical strips. None of the residents are on any medications that need refrigeration. The food supply was also reviewed and perishable foods and non-perishable foods were observed for 4 residents and should be supplemented to last 2 days for perishables and 7 days non-perishables for 6 residents and staff. The water temperature was also tested in the common bathroom and it read 93.8 degrees Fahrenheit since the facility has tankless water heaters.. The temperature in the home read 90.6 degrees Fahrenheit. The kitchen gas stove was operational but needed to be lit manually. The home was without electricity from 7/5/25-7/9/25 and the Licensee failed to report the power outage to the Department. Any deficiencies not addressed on today's visit, will be addressed on a return visit. With the assistance of the Department and the Landlord, the electricity was restored around 5:24pm Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Civil penalties were assessed from 7-5-25 through 7/9/25 at $100 per day for each day for at total of $500 that the licensee did not provide the required notification, Appeals Rights were discussed and a copy provided. Marina Martirosian, Staff, was also advised to have the Licensee/Administrator contact the Department as soon as possible, but no later than 7/10/25.the state’s words, verbatim · CDSS document, Jul 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(b)(2) · Plan of correction due date: Jul 10, 2025

Maintenance and Operation: A comfortable temperature for residents shall be maintained at all times.The facility shall cool rooms to a comfortable range, between 78 degrees F(26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature facility has had no electricity since 07/05/2025 and temperatures inside the facility were noted at 90.6 during today's visit, which poses an immediate health, safety or personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 9, 2025

Plan of correction: The property owner contacted the Dept. of Water and Power to coordinate the restoration of electricity to the property by COB on 07/09/2025. The licensee shall show proof of payment to DWP on 07/11/2025 and payment plan confirmation to LPA by COB 07/11/2025. Note: power was restored at 5:24pm on 7/9/25

From the deficiency page — Deficiency type: Type A · Section cited: CCR87303(e)(2) · Plan of correction due date: Jul 10, 2025

Maintenance and Operation: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). facility has had no electricity since 07/05/2025 and the tankless water heater is inoperable without electricity. Hot water temperature measured at 93.8 degrees Fahrenheit during day’s visit which poses an immediate risk to the health, safety or personal rights to the residents in care.the state’s words, verbatim · CDSS document, Jul 9, 2025

Plan of correction: The property owner contacted the Dept. of Water and Power to coordinate the restoration of electricity to the property by COB on 07/09/2025. Once the power is restored, the licensee representative will ensure the water heater is operable and temperatures are within allowable range. Photographic proof of the temperature shall be sent to the LPA by COB 07/10/2025.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Jul 10, 2025

Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility. Based on record review, the licensee did not comply with the section cited above as it was confirmed the facility has a family member, Svetlana Martirosian, present that has no criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 9, 2025

Plan of correction: Licensee representative will send to family member to be fingerprint cleared and associated. The individual will not return to the facility until this is complete and proof has been sent to the LPA by COB 07/10/2025.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.686(a)(5) · Plan of correction due date: Jul 10, 2025

Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception: A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice.Based on observation, the licensee did not comply with the section cited above as it was confirmed the facility has had no electricity since 07/05/2025 due to non-payment to the LADWP. Civil penalty is hereby assessed for $500 for failure to complythe state’s words, verbatim · CDSS document, Jul 9, 2025

Plan of correction: The property owner contacted the Dept. of Water and Power to coordinate the restoration of electricity to the property by COB on 07/09/2025. The licensee will notify the LPA immediately of the power restoration no later than 07/10/2025. ****Power was restored during this visit****

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the complete CARE Inspection Tool. LPA Yee was let into the home by Marina Martirosian, Staff. Staff contacted the Administrator/Licensee, Alexander Otiashvili via telephone and he arrived at 10:44am to conduct the visit. The home is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms, a private and a common bathroom. The home is fire cleared for 6 non-ambulatory residents. The facility has an approved hospice waiver for 6 residents. The following was observed on today's visit: Staff and resident files were incomplete and were missing majority of the required documents and did not meet Title 22 requirements Staff have current first aid training. Evidence of first aid/CPR training expires on 6/17/1925 Staff #1 does not have a criminal record clearance The facility has liability insurance that meets Title 22 requirements of $1 million per incident and $3 million total annual aggregate. The facility does not have training logs/evidence of in-service training conducted. There are no completed Admissions Agreements. Physician's Reports available are not signed and indicate that 2 residents' are considered bedridden. The Administrator will obtain clarification and provide a copy of the updated Physician's Reports to the Department. Citations and Civil penalties will be issued if needed once clarification is obtained. All four residents are on hospice and there are not care plans, services being provided and evidence of staff training. Administrator Certificate for Alexander Otiashevili expires on 5/8/26. Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Civil Penalties were assessed. Deficiencies not addressed on today's visit will be addressed on a return visit. Exit interview was conducted, Appeals Rights were discussed and a copy was provided.the state’s words, verbatim · CDSS document, Jan 27, 2025

Type of visit: Prelicensing

Licensing Program Analyst(LPA) Christine Yee conducted a announced Prelicensing and Component III visit and used the CARE Inspection Tool. LPA Yee met with Alexander Otiashvili, Applicant and Maya Sargsyan, Designated Administrator. The home is a single storey family home consisting of a living room, dining room, kitchen, 3 bedrooms, a private and a common bathroom. The home is fire cleared for 6 non-ambulatory residents. The facility has a waiver for 6 residents. The following were observed on today's visit: the living room is furnished with the appropriate seating, coffee table and a portable electric fire cabinet. the dining room has a table with 6 chairs. Located in the dining room is a locked storage cabinet to be used to store the centrally stored medications and a little cabinet for resident and staff files. the kitchen is equipped with a dishwasher, stove and a microwave. Sufficient perishable and non-perishable foods were observed. Knives are locked in a locked kitchen drawer. Sufficient, utensils, dinner plates, salad plates, bowls, cups, pots and pans were observed. The only fire extinguisher, purchased on 11/12/23 is located between the kitchen and dining room. Bedroom #1 is furnished with 2 twin beds, 2 night stands, 2 lamps, 2 padded seats, 2 dressers and a shared closet. Required linens were observed and extra linens and towels are stored in the residents' closet. Bedroom #2 is furnished with 2 hospital beds, 3 night stands, 2 lamps, 2 chairs, 2 dressers and a large walk in closet. Required linens were observed on the bed and extra linens, blankets and towels were observed in the residents' closet. The slate of the window blinds are warped. Located inside bedroom #2 is a private bathroom equipped with a shower stall, a toilet and a sink. Grab bars and a non-skid mat were observed. Water temperature was tested and read 117.6 degrees Fahrenheit. Bedroom #3 is furnished with 2 full size beds, 2 night stands, 2 chairs, 2 lamps, a shared closet and 2 dressers that do not met Title 22 requirements of 8 cubic feet. Extra linens, blankets and towels were observed. The slates on the window blinds are warped the common bathroom is equipped with a shower stall, a toilet and a sink. Grab bars and non-skid mat was observed. Water temperature was tested and read 117.2 degrees Fahrenheit. the hardwired smoke detectors were tested and were operational. the hardwired carbon monoxide detector located in the living room and in the hallway were tested and were operational. night lights were observed in the hallway and in the bathrooms a first aid kit with the required bandages, gauze, tweezer, scissors and thermometer were observed. per the applicant a first aid manual was ordered but has not arrived. the facility has a landline telephone. Telephone # is (747)264-0332 the backyard was observed to be clean and equipped with a tent, rattan chairs, a metal armchair and bench. Storage shed and cabinets used to store toxins and extra items were observed. Trash cans with tightly sealed covers were observed. Applicant needs to store or discard cardboard boxes, scooter, desk and hospital table. No bodies of water was observed the front yard is clean and used for tenant parking Applicant has received a insurance quote for liability insurance that meets Title 22 requirements. The following needs to be corrected prior to licensure: the warped slates of the window blinds in bedroom #2 and bedroom #3 need to replaced dressers that meet Title 22 requirements of 8 cubic feet per person needs to be provided. evidence of a first aid manual needs to be provided the items that were observed in the backyard need to be discarded or stored away Applicant needs to purchase liability insurance once the facility is licensed COMPONENT III was conducted with Alexander Otiashvili and Maya Sargsyan. Exit interview was conducted.the state’s words, verbatim · CDSS document, Dec 20, 2023