Circle of Grace

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) N. Galarza arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by caregiver staff. Administrator Anna Khachatryan arrived later on to assist with inspection. Administrator has a valid administrator's certificate expiring on 3/8/2027. The following was observed during the inspection: Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities. Operational Requirements: A Dementia and hospice waiver for 6 residents has been approved. A fire clearance for 6 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 5/30/2026. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a single-story home located in a residential area consisting of six (6) bedrooms, two (2) full bathrooms, kitchen, dining room, living room, laundry room, attached garage, and backyard has a patio area with 2 small water fountains and is landscaped with gravel. Rooms are equipped with required furniture and bedding. Cleaning supplies and toxic substances are inaccessible to residents. The facility has two fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Electrical smoke and carbon monoxide detectors were tested and are operational. The facility maintains emergency food supply and water. Emergency Phone numbers, exit plan and programming schedules were posted. The building contains central air conditioning and heating. First aid kits/Manuals are kept in activity rooms; consisting of thermometer, tweezers, scissors, antiseptic, bandages, gauze. Exit doors are free of any obstruction. The last Emergency Disaster drill was conducted on 2/23/2026. *Four surveillance cameras were observed in the indoor common areas and two outdoor cameras. Staffing: A total 9 staff members provide care and supervision to the residents. Personnel Records/Staff Training: Staff have criminal background clearance and training. Five (5) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training is current in files. Resident Records/Incident Reports: A total of six (6) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. No resident have modified diets. Incident Medical and Dental: Centrally stored / 30-Day supply of medications were reviewed. Medical and dental transportation is provided by family. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: One (1) resident receives hospice services and three (3) residents receive home health services. One resident is bedridden. No deficiencies were cited. An exit interview was conducted with Administrator Ani Karapetyan. A copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced annual inspection visit. The purpose of the visit was explained to Indira Balladares. Administrator Anna Khachatryan arrived later. The facility serves elderly residents ages 60 and older. The following were observed/inspected: Infection Control: The Infection Control Plan was reviewed and includes environmental cleaning and disinfection activities. Facility has sufficient Personal Protective Equipment. Operational Requirements: A Dementia and hospice waiver for 6 residents has been approved. A fire clearance for 6 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room 4. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 5/30/2025. Physical Plant/Environment Safety: The facility is a single-story home located in a residential area consisting of six (6) bedrooms, two (2) full bathrooms, kitchen, dining room, living room, laundry room, rear shaded patio area, and attached garage. Front yard is landscaped with grass and back yard is landscaped with gravel. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors were tested and are operational. The facility two (2) fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has a 1st Aid Kit and Manual. Cleaning supplies, knives, and toxic substances are inaccessible to residents. The last Emergency Disaster drill was conducted on 3/29/2025. Room #5's bedroom door is in disrepair. The bottom of the door and bottom door casing has damage caused by wheelchair. Staffing: A total 10 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 3/8/2027. Staff have criminal background clearance and training. Five (5) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training is current. Resident Records/Incident Reports: A total of six (6) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. Medication Administration records are in place. RCFE and Ombudsman complaint posters are posted in the main entryway of the facility. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Residents have modified diets. Incident Medical and Dental: Centrally stored resident medications were reviewed. 30-day supply of medications was observed. Medical and dental transportation is provided by family. There were AM medications on R1's bedside table that had not been administered. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: One (1) resident receives hospice services and two (2) resident receive home health services. There are two (2) residents with Dementia. No residents have prohibited health conditions. Full and half bed rails are used for mobility assistance. Per California Code of Regulations, Title 22, deficiencies were cited. An exit interview was conducted with Administrator Anna Khachatryan. A copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, May 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to caregiver Roberto Rios. Administrator Anna Khachatryan arrived shortly after. There are currently 5 elderly residents 60 years and older residing in the facility. The following 12 Care Compliance and Regulatory Enforcement (CARE) tool domains were utilized during the inspection. Infection Control: The facility has an Infection Control Plan & COVID Mitigation Plan. Supplies of Personal Protective Equipment (PPEs) were observed. Operational Requirements: An Infection Control Plan has been added to the Plan of Operation. The facility has a Dementia Waiver in place and an approved Hospice Waiver for 6 residents. A fire clearance for 6non-ambulatory residents; of which 1 may be bedridden in room $4 is in place. Liability Insurance in the amount of ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 5/30/2024. An American Red Cross 1st Aid kit and manual are readily available. No Surety bond is in place. Facility does not handle resident monies. *Narrative continues next page. Physical Plant/Environment Safety: The facility is a single-story home located in a residential area consisting of six (6) bedrooms, two (2) full bathrooms, kitchen, dining room, living room, laundry room, rear shaded patio area, and attached garage. The facility has two (2) fully charged fire extinguishers. Smoke and carbon monoxide detectors are operational. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances in the unlocked laundry room were observed accessible to residents. A citation was issued. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. None of the resident beds had mattress pads. A citation was issued. Residents (R3 & R5) have oxygen tanks in their rooms, but a a "No Smoking-Oxygen in Use" sign was not posted in appropriate area i.e., near the room door or at the facility entrance. A citation was issued. Staffing: A total of six (6) staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expires 3/8/2025. Four (4) staff files were reviewed. Proof of staff training, health clearance, food handling certificates, and 1st Aid/CPR training was observed. Staff have criminal background clearance and training. Resident Records/Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent, Individual Service Plans, and medication records. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar is posted in the hallway. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. One (1) resident has a physician order for modified diet. Incident Medical and Dental: Three (3) centrally stored resident medications were reviewed to verify there is a 30-day supply of medications. Resident (R1's) Irbesatan 300 mg & Alendronate Sodium 70 mg medications have not been refilled. A citation was issued. Medical and dental transportation is provided. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Records of resident Appraisal and Needs services plans are part of Emergency training. Residents with Special Health Needs: Three (3) residents are receiving hospice services. One (1) resident receives home health services. Postural support physician orders are on file. Full and half bed rails for mobility assistance were observed in some resident rooms. No residents have prohibited health conditions. Appraisals are on file. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Anna Khachatrya. A copy of the report and appeal rights will be emailed today due to printing difficulties.the state’s words, verbatim · CDSS document, Apr 30, 2024