Courtyard Plaza

Allegation investigated: . Licensee is not ensuring faucets used by residents for personal care deliver hot water

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Marilou Mendoza, Administrator. The reason for the visit was provided. On today's visit LPA Yee conducted an interview with Marilou Mendoza at 2:22pm and conducted a tour of the bathrooms located in bedrooms #301, #303, #304, #305 and #306 beginning at 2:56pm together with the Administrator and Julio Argueta, Maintenance. The water temperature taken in bedroom #301 read 104.9 degrees and then dropped down to 93.0 degrees, bedroom #303 read 102.0degrees and dropped to 94.3 degrees, bedroom #304 read 102.0 degrees and then dropped to 96.3, bedroom #305 read 109.4 degrees and fluctuated slightly and bedroom #306 read 108.9 degrees and also fluctuated but held at the noted temperature. The water temperature in bedrooms #301, #303 and #304 never attained the required Continued on LIC9099-C Substantiated Page 2. temperature range of 105-120 degrees Fahrenheit on today's visit. Per interviews conducted with the Administrator and verified with Maintenance, repairs were conducted each time the facility was cited for the lack of hot water. The facility was previously cited on 11/25/25 and again on 6/25/26 for the lack of hot water for resident use. Facility records, indicate repairs were made on 7/2/26 and evidence was submitted to the Department that the deficiency was corrected by 7/9/26. Despite the evidence provided for the correction, the Department received a third complaint on 7/13/26 that the licensee is not ensuring faucets used by residents for personal care deliver hot water. The repairs conducted are not permanently addressing the ongoing problem with the faucets not consistently delivering hot water within the range of 105-120 degrees Fahrenheit. The water temperature taken today in the rooms identified as not receiving hot water confirm the allegation in the complaint. Based on today's visit and tour of the bathrooms there is sufficient evidence to support the allegation that Licensee is not ensuring faucets used by residents for personal care deliver hot water, therefore the allegation is substantiated at this time. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Civil penalties of $250.00 were assessed. Exit Interview was conducted, Appeals Rights were discussed and a copy was provided.the state’s words, verbatim · CDSS document, Jul 15, 2026 · control 29-AS-20260713111756

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(2) · Plan of correction due date: Jul 22, 2026

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).. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as water temperature measured in three (3) out of the five (5) resident rooms were below 105 degree F; This poses a potiential health and safety risk to residents in care. Civil Penalties were assessed for repeat violation within 12 months.the state’s words, verbatim · CDSS document, Jul 15, 2026

Plan of correction: The Licensee will contact their plumbing vendor to have them diagnose the ongoing problem with the lack of hot water that should have been corrected on 7/2/26 and to conduct any additional repairs. The Licensee will also conduct daily water temperature checks in various residents rooms and maintain a log to document and ensure the water temperature is stablized and attains the required range of 105-120 degrees Fahrenheit. Provide a copy of the repairs completed by 7/22/26 and weekly logs to LPA for a month after the repairs are completed.

Allegation investigated: . Staff do not ensure resident has hot water

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Mariou Mendoza, Administrator. The reason for today's visit was provided. LPA Yee conducted an interview with Marilou Mendoza at 11:14am, conducted a tour of Room #125 at 11:39am, Room 127 at 11:44am, Room 124 at 12:40pm, Room 120 at 12:45pm and Room #116 at 12:49pm and tested the water temperature in the rooms on today's visit. Also obtained was a copy of the bill for the plumbing repairs conducted on 6/24/26. Per information obtained from the Administrator regarding the allegation that staff do not ensure resident has hot water, it was revealed that Bedroom # 124 and Bedroom 125 do not get hot water. Per the Administrator, the plumbers were here yesterday (6/24/26) to fix the problem. The plumbers intially continued on LIC9099-C Substantiated Page 2. attributed the fluctuating hot water problem to the pipes and then discovered that it was not the pipes. She believes it is a problem with the water heaters. Per the Administrator, the residents get hot water but,the hot water fluctuates and does not last to allow the resident to shower. After yesterday's repair, Resident #2 indicated that they were getting hot water but when maintenance tested the water in the room this morning, there was no hot water. The Administrator was not sure if Resident #1 had hot water as of the interview conducted. Per tour of the rooms conducted on this visit, the water temperature was taken in each bathroom. The water temperature in bedroom #120 read 116.1 degrees, bedroom #116 read 112.2 degrees, bedroom #124 read 95 degrees, bedroom #125 read 95 degrees, bedroom #127 read between 95 to 100 degrees Fahrenheit. Per information provided by the Administrator and maintenance and observed during the water temperature check, some of the water temperature readings would be within Title 22 range of 105-120 but when it was re-checked the readings would be lower. The water temperature would fluctuate. Per interviews conducted with Resident #1 and Resident #2, they do not have hot water. Per Resident #1, they do not shower in their bathroom. They have to use another available room. Per Resident #2, there has been no hot water since October 2025. The water temperature has remained below 100 degrees Fahrenheit. They have been taking cold sponge baths from the sink. Per Resident #2, on 6/24/26, they actually had hot water and they were able to wash and rinse their hair but later in the day and as of early this morning (6/25/26) there is no hot water. They had hot water and it got taken away. Per review of Department records, the facility was previously cited on 11/25/25 for not having hot water for resident use. Based on today's investigation, the allegation that Staff do not ensure resident has hot water is determined to be SUBSTANTIATED at this time. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Civil penalties were also assessed for a repeat violation.the state’s words, verbatim · CDSS document, Jun 25, 2026 · control 29-AS-20260617151100

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(2) · Plan of correction due date: Jul 9, 2026

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).. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as water temperature measured in three (3) out of the five (5) resident rooms were below 105 degree F; This poses a potiential health and safety risk to residents in care. Civil Penalties were a repeat violation within 1year.the state’s words, verbatim · CDSS document, Jun 25, 2026

Plan of correction: Per the Administrator, the plumbers were here on 6/24/26 to conduct repairs to the water heaters but the water temperature issue has still not been corrected. The water temperature issue previously cited on 11/25/25 has not been corrected. Licensee will contact the plumbers to stabilize the water temperature between 105-120 degrees Fahrenheit. The facility will test the water daily in the rooms toured to ensure the required Title 22 temperature is attained or addressed. Licensee will provide evidence of correction and a copy of the 14 day temperature log by 7/9/26

Allegation investigated: . Staff did not seek medical attention in a timely manner resulting in resident passing away. 2. Staff did not ensure resident's medical needs were being met. 3. Staff did not provide transportation for resident's doctor's appointments.

Licensing Program Analyst (LPA) Christine Yee conducted a subsequent complaint visit to conduct further investigation and to deliver the findings for the above allegations. LPA met with Marilou Mendoza, Administrator and explained the reason for the visit. On the allegation: Staff did not seek medical attention in a timely manner resulting in resident passing away. On 11/24/2025, Community Care Licensing (CCL) received a complaint alleging a resident passed away due to the facility not seeking timely medical attention. The Department conducted an investigation. On 11/25/2025, from 9:09am to 5:00pm, Licensing Program Analysts (LPAs) Yee and Chochian conducted an unannounced complaint visit. During this visit, LPAs toured the facility, collected relevant documents Continued on LIC9099-C Unsubstantiated Page 2. including Special Incident Reports with fax confirmations, and documents for Resident 1 (R1) and Resident 2 (R2). On 12/24/2025, at approximately 5:28 pm the Department conducted interviews with Designated Responsible Staff, Aaron Feingold; on 3/10/2026 at 2:24pm conducted interviews with Family 1 (F1); and on 3/13/2026, at 9:46 am conducted interview with former administrator Denise Gilroy. The Department attempted multiple times to interview former Staff 1 (S1), who was the staff directly involved when R1 went to the hospital. However, S1 did not show up to the interview location and did not answer additional attempts to contact them for interview. R1’s facility file was reviewed, including home health records and Incident reports. Records provided that R1 had diagnoses of Anemia, End Stage Renal Disease, Type 2 Diabetes, and was on Dialysis. R1 did not have any cognitive conditions and is able to communicate. Per R1’s medical assessment and care plan, R1 requires assistance with dressing, grooming, showering, incontinence care, and medication management. During the investigation, medical records from Valley Presbyterian Hospital and home health records from Savanna Home Care, Inc. were collected and reviewed. R1’s home health records confirmed that the resident was receiving skilled nursing visits every day, prior to being transferred to the hospital. The home health records also confirm that the resident developed a Stage 1 pressure injury on 10/10/2025, and R1 received a referral for wound care the same day. On 10/13/2025, the home health records updated that the wound had progressed to a Stage 2 pressure injury. On 10/14/2025, R1 was transported to the hospital and arrived around 11:13am. Per the Incident Report, R1 complained of right leg pain and the Administrator called 9-1-1. Records indicate the “Dispatch Complaint” for R1 was a “Diabetic problem” and the chief complaint was altered mental status. Hospital records indicate R1’s sacrococcyx wound was “unstageable” on 10/14/2025 at 11:30pm. R1 was admitted to the hospital due to the altered mental status, bradycardia, and hyperkalemia. Medical records indicate R1 had a history of end-stage-renal disease, was blind, and previously had a stroke' Continued on LIC9099-C Page 3. Hospital records state R1 was admitted to the intensive care unit for “ongoing management of sepsis.” R1 had a previous diagnosis that included “bloodstream infection due to central venous catheter,” “sepsis due to methicillin resistant Staphylococcus Aureus,” and “other toxic encephalopathy.” Records state “In 2023 the patient sustained a distal femur fracture treated with a retrograde intramedullary nail (since removed), followed by a subsequent left hip fracture stabilized with an antegrade trochanteric entry nail.” A surgical procedure was scheduled on 10/27/25 to “remove the infected hardware”, but R1 passed away on 10/27/25 at the hospital. During the interview with F1, they stated “[R1] didn’t want to go” to the hospital, “[R1] was still conscious” and the facility staff had to make a “second request” to have R1 transported to the hospital. F1 stated “they called me twice” to advise F1 that they were attempting to send R1 to the hospital. F1 did not believe the facility was neglectful in R1’s care, and indicated they felt the facility did a good job at monitoring R1’s change in conditions. F1 confirmed R1 was not in good health. During an interview with former Administrator Denise Gilroy, administrator stated they were present during the incident where R1 was sent to the hospital, and stated that Staff #1 (S1) caused a delay in R1 being sent to the hospital because S1 had failed to call 9-1-1, and instead called a private ambulance. Information received from the reporting party confirmed there was a delay in calling 9-1-1 despite R1 being unresponsive and having low blood pressure. Designated Responsible Staff Feingold also confirmed S1 called for non-emergent transportation for R1 instead of following 911 protocol. S1, former employee was not technically terminated by the facility, but employment ended due to “Job Abandonment” after they did not show up for work for three (3) consecutive days. Based on the interviews and records reviewed, home health was attending to R1 on a daily basis, and the facility did ultimately seek medical attention for R1. There was insufficient evidence to prove that the untimely medical attention directly caused R1’s death. Although the allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred therefore the allegation is Unsubstantiated Continued on LIC9099-C Page 4. at this time. The admitted lack of timely medical attention for R1 will be addressed on a separate case management visit. On the allegations: Staff did not ensure resident's medical needs were being met and Staff did not provide transportation for resident's doctor's appointments. It was alleged R2 had a Stage 3 pressure injury that did not receive any medical attention, such as home health. In addition, no medical appointments with R2’s doctor or hospital visits occurred. R2’s physician’s report indicates they are able to care for their own activities of daily living, administer their own medications, had on cognitive impairment, and are able to communicate their needs. Facility records indicate R2 was sent to the hospital on 11/12/2025 and 11/20/2025. LPA reviewed an incident report that stated on 11/20/2025, a Med Tech contacted R2’s Primary Care Physician regarding an “active wound” and was in need of Home Health. The facility did not receive a follow up call and sent R2 to the hospital for evaluation. Per review of hospital documents provided for R2's hospital visit on 11/12/25 hospital visit, R2 went to the hospital due to a fall that morning. R2 had sustained an elbow contusion and had to wear a sling. Hospital paperwork also indicated that R2 had also sustained a skin tear on the right hand and would need wound care for it to heal. Hospital documents do not refer to any pressure injuries. Per interviews with Staff, Resident #2 had a history of falls and would sustain skin tears. Resident #2 did not have pressure injuries. Resident #2 also has a history of cellulitis on the legs. The facility attempted to secure medical attention and Home Health once the wound was discovered. Once it was determined the Primary Care Physician was not responding quickly enough, the resident was sent to the hospital on 11/20/25 to have the wound evaluated because it looked infected. Although the allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred therefore the allegations that Staff did not ensure resident's medical needs were being met and Staff did not provide transportation for resident's doctor's appointments are Unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Exit interview was conducted and a copy of this report was provided. Page 2. time frame. Per review of Department records, no incident report was submitted for the hospitalization of of Resident #1 on 10/14/25. Based on the information obtained, the allegation is deemed Substantiated at this time. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, APPEALS RIGHTS were discussed and copy of report and appeal rights were providedthe state’s words, verbatim · CDSS document, Jun 4, 2026 · control 29-AS-20251124083503

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jun 11, 2026

Reporting Requirements: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below.....This requirement was not met evidenced by: The facility did not report the incidents, noted in the complaint within the required time frame or have fax confirmation of reporting until 11/25/25. Also noted, the hospital visit for Resident #1 on 10/14/25 has not been reported as of today's visit.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: Licensee will read Section 87211-Reporting Requirements and submit a signed written statement that the section was reviewed and understood by 6/11/26. Licensee will also complete an incident report (LIC624) for R21's 10/14/25 hospital visit and submit by 6/5/26.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit to issue a deficiency found while investigating complaint # 29-AS-20251124083503. LPA Yee met with Marilou Mendoza, Administrator and explained the reason for the visit. On 11/24/2025, Community Care Licensing (CCL) received a complaint alleging a resident passed away due to the facility not seeking timely medical attention. The Department conducted an investigation. On 11/25/2025, from 9:09am to 5:00pm, Licensing Program Analysts (LPAs) Yee and Chochian conducted an unannounced complaint visit. During this visit, LPAs toured the facility, collected relevant documents including Special Incident Reports with fax confirmations, and documents for Resident 1 (R1) and Resident 2 (R2). On 12/24/2025, at approximately 5:28 pm the Department conducted interviews with former Administrator Aaron Feingold; on 3/10/2026 at 2:24pm conducted interviews with Family 1 (F1); and on 3/13/2026, at 9:46 am conducted interview with former administrator Denise Gilroy. The Department attempted multiple times to interview former Staff 1 (S1), who was the staff directly involved when R1 went to the hospital. However, S1 did not show up to the interview location and did not answer additional attempts to contact them for interview. R1’s facility file was reviewed, including home health records and Incident reports. Records provided that R1 had diagnoses of Anemia, End Stage Renal Disease, Type 2 Diabetes, and was on Dialysis. R1 did not have Continued on LIC809-C Page 2. any cognitive conditions and is able to communicate. Per R1’s medical assessment and care plan, R1 requires assistance with dressing, grooming, showering, incontinence care, and medication management. During the investigation, medical records from Valley Presbyterian Hospital and home health records from Savanna Home Care, Inc. were collected and reviewed. R1’s home health records confirmed that the resident was receiving skilled nursing visits every day, prior to being transferred to the hospital. The home health records also confirm that the resident developed a Stage 1 pressure injury on 10/10/2025, and R1 received a referral for wound care the same day. On 10/13/2025, the home health records updated that the wound had progressed to a Stage 2 pressure injury. On 10/14/2025, R1 was transported to the hospital and arrived around 11:13am. Per the Incident Report, R1 complained of right leg pain and the Administrator called 9-1-1. Records indicate the “Dispatch Complaint” for R1 was a “Diabetic problem” and the chief complaint was altered mental status. Hospital records indicate R1’s sacrococcyx wound was “unstageable” on 10/14/2025 at 11:30pm. R1 was admitted to the hospital due to the altered mental status, bradycardia, and hyperkalemia. Medical records indicate R1 had a history of end-stage-renal disease, was blind, and previously had a stroke. Hospital records state R1 was admitted to the intensive care unit for “ongoing management of sepsis.” R1 had a previous diagnosis that included “bloodstream infection due to central venous catheter,” “sepsis due to methicillin resistant Staphylococcus Aureus,” and “other toxic encephalopathy.” Records state “In 2023 the patient sustained a distal femur fracture treated with a retrograde intramedullary nail (since removed), followed by a subsequent left hip fracture stabilized with an antegrade trochanteric entry nail.” A surgical procedure was scheduled on 10/27/25 to “remove the infected hardware”, but R1 passed away on 10/27/25 at the hospital. During the interview with F1, they stated “[R1] didn’t want to go” to the hospital, “[R1] was still conscious,” and the facility staff had to make a “second request” to have R1 transported to the hospital. F1 stated “they Page 3. called me twice” to advise F1 that they were attempting to send R1 to the hospital. F1 did not believe the facility was neglectful in R1’s care, and indicated they felt the facility did a good job at monitoring R1’s change in conditions. F1 confirmed R1 was not in good health. During an interview with former Administrator Denise Gilroy, administrator stated they were present during the incident where R1 was sent to the hospital, and stated that Staff #1 (S1) caused a delay in R1 being sent to the hospital because S1 had failed to call 9-1-1, and instead called a private ambulance. Information received from the reporting party confirmed there was a delay in calling 9-1-1 despite R1 being unresponsive and having low blood pressure. Former Administrator Feingold also confirmed S1 called for non-emergent transportation or R1 instead of following protocol. S1 was not technically terminated by the facility, but employment ended due to “Job Abandonment” after they did not show up for work for three (3) consecutive days. Based on the interviews, admissions, and records reviewed, the facility did not provide R1 timely medical attention after they rapidly declined, and staff did not follow the protocol to immediately call 9-1-1 Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted, Appeals Rights discussed and a copy was provided..the state’s words, verbatim · CDSS document, Jun 4, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Jun 5, 2026

Incidental Medical and Dental Care: The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis…This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited when R1 was not given timely medical attention on 10/14/25. 911 was not immediately called which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: The Licensee will review their 911 protocol and provide current staff training to ensure that all staff know exactly when 911 is to be immediately contacted during an apparent medical crisis instead of endangering the health of the resident by unnecessay delays. Licensee will provide a written statement that they have reviewed their emergency protocol by 6/5/26 and have provided immediate staff training about the emergency protocol. Licensee will submit evidence of the completion of staff training about calling 911 when there is a life threatening medical crisis by no later then 6/11/26.

Allegation investigated: . Staff are not meeting resident's medical needs.

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and initially met with Marcela Pereira, Medication Technician. Marilou Mendoza, Executive Director arrived at 9:46am to conduct the visit. The reason for today's visit was provided. On today's visit, LPA Yee conducted an interview with Marcela Pereira, Medication Technician at 9:35am, Executive Director at 9:48am and a telephone interview with Witness #1 at 10:45am. A copy of Resident #1's file was obtained during the visit. Per interviews conducted and information obtained, Resident #1 has severe right knee pain and the family wanted to have the resident's doctor take a look at the knee. A family member contacted the doctor's office continued on LIC9099-C Unsubstantiated Page 2. and an appointment was scheduled to have the doctor visit Resident #1 at the facility on 4/24/26. The facility staff was not made aware of the scheduled visit by the family or the medical provider's office. The Executive Director was made aware of the missed appointment by the resident's responsible party on 4/24/26. Per the Executive Director, she called the provider's office for a reason for the missed appointment and was told that due to internal mis-communication the appointment was missed. An appointment was re-scheduled with Resident #1's responsible party for May 1, 2026. The Executive Director was notified by phone of the rescheduled appointment on 4/29/26 by the responsible party. Per contact with Witness #1, the family is not happy with Resident #1's current medical provider and is in the process of switching to another Doctor. Per Witness #1, the family does not have any issues with the facility staff or the Executive Director. Per Witness #1, contact had been made with the Long Term Care Ombudsman's office and they were referred to Community Care Licensing to file the complaint, Per Witness #1, the complaint is against the medical provider not the facility. LPA Yee was notified at 10:46am that personnel from the current medical provider's office was on-site during today's visit. Based on the information received on today's visit, there is no evidence to support the allegation that staff are not meeting resident's medical needs, therefore the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 1, 2026 · control 29-AS-20260428145634

Allegation investigated: Licensee did not ensure staff have criminal record clearance and/or exemption prior to presence in the facility

Licensing Program Analysts (LPA’s) Christine Yee and Erica Mosley conducted the initial 10-day complaint visit to investigate the above-listed allegation. Upon arrival approx. at 10:10 a.m., LPA's were greeted by front desk staff and Assistant Administrator, Aaron Feingold. Evelina Papazyan, Consultant arrived at 11:45 a.m. and the reason for the visit was explained. Entrance interview conducted. On 12/22/2025, the Department received a complaint regarding the following allegation, Licensee did not ensure staff have criminal record clearance and/or exemption prior to presence in the facility. During today's visit starting at 11:20 a.m. LPA's toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. Starting at 10:35 a.m., and throughout the visit LPA’s conducted three (3) in person, staff interviews and obtained copies of pertinent documents relevant to the investigation. Report continued on LIC 9099-C PAGE 2... Unsubstantiated (PAGE 2) Report continued from LIC 9099... On the allegation Licensee did not ensure staff have criminal record clearance and/or exemption prior to presence in the facility it is the concern of the Reporting Party (RP) that Staff #1 (S1) and Staff #2 (S2) who work in the kitchen have been working at the facility without a criminal record clearance. To investigate this complaint LPA’s conducted three (3) in person interviews with the Administrative Assistant at 10:35 a.m., the Dishwasher at 11:29 a.m. and the Cook at 11:34 a.m. LPA's reviewed the live Guardian roster and reviewed and obtained copies of pertinent documents relevant to the investigation. Interviews with the Administrative Assistant revealed that the facility had a case management visit conducted on 11/18/2025 and were cited for criminal record clearance for both S1 and S2. Since 11/18/2025 both S1 and S2 have not returned to work at the facility, and as of today they do not plan on having them return. It was also noted that the facility disassociated S1 at the time of the visit on 12/29/2025. Interview with the Dishwasher revealed that S1 did work at the facility, however since the visit on 11/18/2025 S1 has not returned to work at the facility. S2 worked at the facility occasionally to fill in, however since 11/18/2025 has not returned to work at the facility. Interview with the Cook revealed that S1 no longer works at the facility and has not returned since 11/18/2025. S2 was occasionally working at the facility filling in when coverage was needed, however S2 has not returned to work at the facility since 11/18/2025. At 12:30 p.m. live Guardian roster review revealed that S1 was added to the facility roster on 11/18/2025 with a pending status and is still showing as pending. S2 is not listed on the facility roster. At 4:00 p.m. a live Guardian roster review revealed that S1 was separated from the facility as of 11/18/2025. Facility records revealed that on the Personnel Report- LIC 500 dated 12/15/2025 it does not list S1 or S2. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Licensee did not ensure staff have criminal record clearance and/or exemption prior to presence in the facility is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report provided.the state’s words, verbatim · CDSS document, Dec 29, 2025 · control 29-AS-20251222122103

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Christine Yee and Erica Mosley conducted a joint unannounced required Annual Inspection using the CARE Inspection Tool and met with Aaron Feingold, Designated Responsible Staff. Also participating in today's visit was Evelina Papazyn, Consultant. The reason for today's visit was explained. The facility is a 3 storey residential building consisting of 30 bedrooms, a commercial kitchen, dining room, television room, lounge and a staff break room on the first floor. The second floor has 35 bedrooms, dining room, library and television room. 16 bedrooms out of the 35 bedrooms are designated for the dementia unit. The third floor has 36 bedrooms. The facility is fire cleared for 63 Ambulatory, 112 Non-ambulatory and 20 bedridden residents. Delayed egress is approved for the dementia unit. On today's visit, all 12 domains of the CARE Inspection Tool was reviewed, 8 staff and 8 resident files were reviewed and a tour of the physical plant, inside and outside were toured. Medications were also reviewed beginning at 3:00pm.The following rooms were inspected on today's visit: Room #s 101, #108, #124, #206, #212, #221, #234, #301, #316 and #335. Per tour of the resident rooms inspected, the rooms contained the required furniture. The bathrooms all contained a toilet, shower, grab bars, shower chair and a slip resistant mat. The water temperature were tested in the bathrooms and the water temperature in some of the bathrooms met Title 22 requirements and some did not have any hot water as the plumbers were still working on the plumbing needed to correct the continued on LIC809-C Page 2 facility's issues with correcting the uneven distribution of hot water throughout the facility that was previously cited on a complaint visit conducted on 11/25/25. Per the facility, the previous contracted plumbing company came to fix the water temperature problem to meet Title 22 requirements but the problem was not fixed. Another plumbing company had to be hired to address the problem with the water temperature and they were on site working on the problem on today's visit. Per the contractor, the plumbing should be addressed by 12/30/25. Per tour of the inside common areas, the appropriate furnishing and equipment were in place for its designated use. Per tour of the kitchen, sufficient perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed on site. The facility also has food supplies delivered 2 times a week on Monday and Thursday. The common areas were observed to be clean and well maintained. The facility has 3 fire extinguishers located on each of the 3 floors. They were last inspected on 2/12/25. The last fire inspection was conducted on 2/17/25 by the facility's fire vendor and the facility passed the fire inspection for all fire prevention equipment. The facility has current general liability insurance that meets Title 22 requirement. Per tour of the outside areas, there were chairs and tables available for resident use on the ground level and second floor. The large dumpsters located in the back parking lot were observed tightly sealed and in good condition. The outside areas were observed to be clean. No deficiencies were cited on today's visit. Exit interview was conducted.the state’s words, verbatim · CDSS document, Dec 29, 2025

Allegation investigated: Facility’s hot water is in disrepair.

Licensing Program Analyst(s) Zabel Chochian and Christine Yee met with Assistant Administrator Aaron Finegold and later with the Administrator Brittney Buchannan. Reason for the visit was discussed. In reference to the allegation above, it was reported that the facility does not maintain sufficient hot water delivery throughout resident bathrooms. To investigate this allegation, LPA began the physical plant tour from approximately 10:00am to 12:15pm. Durinng the tour LPA inspected eight (8) resident rooms/bathrooms, interviewed staff and residents. The hot water in rooms 332, 130, 128, 126, and 231, measured from 93.5 to 102.1 degrees fahrenheit; rooms 333 and 337 measured from 108.7 - 111.4 degrees fahrenheit; room 212 measured at 122.8-124 degrees fahrenheit. Although during the visit, Mr. Finegold stated that they are work on replacing pipes to rectify the issues, it was determined, that the facility hot water is not consistantly within the required range (105-120) at this time. Based on the information gathered during todays's investigation, allegation "Facility's hot water is in direpair" is SUBSTANTIATED at this time. Substantiatedthe state’s words, verbatim · CDSS document, Nov 25, 2025 · control 29-AS-20251121104819

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

Maintenance and Operation. 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 and not more than 120 degree F. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as water temperature measured in four (4) out of the eight (8) resident rooms were below 105 degree F; one out of eight rooms was above 120 degree F. This poses a potiential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 25, 2025

Plan of correction: The Designated Administrator and Assistant Administrator reported that they are currently working on changing pipes which will rectify the hot water issue. Administrators agreed to do the following: 1. Have the water heaters adjusted within the next 24 hours. 2. Conduct a 7 day water temperature log for ten rooms on each side spread throughout the facility. Include rooms 332, 130, 128, 126, 231 and 212. Ensure that the hot water temp. is maintained with in required range of 105-120. Submit confirmation of work completed and water temp. log by 12/2/2025.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit due to deficiencies observed during a visit to the facility today. LPA Yee met with Brittany Buchanan, Staff and Aaron Feingold, Administrative Assistant. The reason for the visit was provided. The following was observed on today's visit: Per review of the facility's Personnel Report, Walter Perez worked in the kitchen on 10/28/25 and was let go the same day, Gregory LaRue was hired as a cook on 11/12/25 and has not obtained a criminal record exemption to be present at the facility. Rosa Garcia and Consuelo Rodriguez were not associated to the facility until today - 11/18/25 Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. CIVIL PENALTIES WERE ASSESSED. Any other deficiencies noted on today's visit will be addressed at a later date. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 18, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(4) · Plan of correction due date: Nov 19, 2025

Criminal Record Clearance-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: Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. Gregory LaRue(DOH 11/12/25) requested an criminal record exemption but has not received approval to be present at the facility. $500 Civil Penalties were assessed.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: The Licensee will ensure that all staff have requested and been approved of a criminal record exemption prior to being present at the facility. The Licensee will review Title 22, Section 87355-Criminal Record Clearance and submit a written statement that the section was read and understood and how the licensee shall ensure compliance by 11/19/25. The Licensee will also immediately remove the employee from the premises until the facility has received an approved criminal record exemption.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: Nov 19, 2025

87355 Criminal Record Clearance. 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: 2)Obtain a California clearance or a criminal record exemption Walter Perez, worked at the facility on 10/28/25 for one day. Rosa Garcia(DOH 2/9/17) & Consuelo Rodriguez(DOH 3/18/17). No criminal record clearance or transfer were obtained for all 3 staff prior to being present at the facility. $1100 -Civil Penatlies were assessed.the state’s words, verbatim · CDSS document, Nov 18, 2025

Plan of correction: The Licensee will ensure that all staff have requested and been approved of a criminal record exemption prior to being present at the facility. The Licensee will review Title 22, Section 87355-Criminal Record Clearance and submit a written statement that the section was read and understood and how the licensee shall ensure compliance at all times by 11/19/25. Rosa Garcia and Consuelo Rodriguez were associated to the facility today 11-18-25, during this visit and Walter Perez was not retained.

Allegation investigated: . Facility staff did not prevent physical altercation between residents

Licensing Program Analyst(LPA), Christine Yee, conducted an unannounced complaint visit to investigate the above allegation and met with Aaron Feingold, Administrative Assistant, since Brittany Buchanan, who was recently designated as the Administrator was not present at the facility during this visit. LPA Yee was not notified of the Administrator change and was not provided with the required Administrator documents for review. The reason for today's visit was explained. On today's visit LPA Yee conducted an interview with Aaron Feingold at 12:21pm, Staff #1 at 12:54pm, Resident #1 at 1:53pm and Staff #2 at 2:00pm. Files for Resident #1 and Resident #2 were reviewed and copies of documents were requested throughout the visit. Medications for Resident #2 were also reviewed. Continued on LIC9099-c Unsubstantiated Per information received from interviews conducted regarding the allegation that facility staff did not prevent physical altercation between residents, investigation revealed that on 11/1/25, around 11am/11:30am, just before lunch, Staff #2 was assisting Resident #3 in the TV Room located in Memory Care, when Staff #2 heard Resident #1 and Resident #2 having a very loud verbal fight and profanity was being thrown around by Resident #2 in the dining room. Per Staff #2, they immediately went over to see what was happening and observed Resident #1 drenched in juice. Per Staff#2, they did not observe the juice being thrown or if there were any physical contact between the 2 residents. Both residents were not observed with any injuries or bruises. Staff #2 just observed that Resident #1 was soaked. They stood between the 2 resident to prevent the residents from reaching each other. Per Staff #2, as they are going towards the 2 residents, they called Staff #1 for assistance. Staff #1 arrived immediately and Staff #2 continued assisting other residents with lunch. Per Staff #1, Resident #2 was very agitated, aggressive and yelling at staff and following them. Staff #1 called the family to see if they could come to the facility to calm Resident #2 but the family advised staff that they couldn't until the following day. They did not have a vehicle. Staff #1 called private transportation to send Resident #2 to the hospital but resident refused to be assessed and was very aggressive with the ambulance personnel and refused to comply. They advised staff to call the PET team to have Resident #2 assessed for a 5150 hold. The PET team was contacted around 3pm and due to a high volume of calls the PET team did not arrive until about 6pm that evening with law enforcement to assist. Resident #2, still very agitated, refused to be assessed by the PET team and refused to let the team into their room and attempted to slam the door on them. Eventually, Resident #2 complied with law enforcement's request to get on the gurney and was transported to the hospital for assessment. Resident #2 was diagnosed with confusion, agitation and urinary tract infection. At the time of admission to the facility, Resident #1 was diagnosed with Alzheimer and was admitted to the facility on 10/30/25, without any medications. Resident #2 returned to the facility on the evening of 11/3/25 with prescribed medications and is currently calm. Based on today's investigation, the facility residents do not require one to one supervision and are allowed to mingle with other residents. Staff cannot anticipate when a resident is going to have a behavior but can only be available when intervention is needed. The incident between Resident #1 and Resident #2 was not anticipated and could not have been prevented even if staff were present. Per the investigation, the appropriate actions were taken by staff to mitigate any further harm, therefore the allegation that facility staff did not prevent physical altercation between residents is deemed unsubstantiated at this time. Exit interview was conducted.the state’s words, verbatim · CDSS document, Nov 5, 2025 · control 29-AS-20251103124305

Allegation investigated: Facility does not allow residents to choose their home health agency.

Licensing Program Analyst (LPA) Erica Mosley conducted an initial 10-day complaint visit to investigate the above allegation. Upon arrival approx. at 9:50 a.m., LPA Mosley was greeted by front desk staff and Assistant Administrator, Aaron Feingold. At 10:00 a.m. LPA met with acting Administrator, Denise Gilroy and the reason for the visit was explained. Entrance interview conducted. On 08/29/2025, the Department received a complaint regarding the following allegation, Facility does not allow residents to choose their home health agency. During today's visit at 9:50 a.m. LPA and staff briefly toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards, and facility is in compliance with Title 22 Regulations. Starting at 10:30 a.m. LPA conducted an interview with the Administrator, at 10:47 a.m. conducted a file review on eight (8) residents who are currently on home health, at 11:36 a.m. and 11:44 a.m. conducted telephonic interviews with a family member and Doctors office of a resident on home health. Report continued on LIC 9099-C PAGE 2... Unsubstantiated (PAGE 2) Report continued from LIC 9099... Starting at 11:50 a.m. conducted four (4) in-person interviews, with residents currently on home health, attempted two (2) additional resident interviews, however residents were unavailable and out in the community at the time of the visit. At 12:32 p.m. conducted one (1) staff interview and obtained copies of pertinent documents relevant to the investigation. On the allegation Facility does not allow residents to choose their home health agency it is the concern of the Reporting Party (RP) that the facility Administrator pressures/directs residents to sign up with a specific agency. To investigate this complaint, LPA conducted an interview with the Administrator at 10:30 a.m., at 10:47 a.m. conducted a file review on eight (8) residents who are currently on home health, at 11:36 a.m. conducted telephonic interview with a family member of a resident currently on home health at 11:44 a.m. conducted a telephonic interview with a Doctors office of a current resident on home health, at 11:50 a.m. conducted four (4) in-person interviews, with residents currently on home health, at 12:32 p.m. conducted one (1) staff interview and obtained copies of pertinent documents relevant to the investigation. Interview with the Administrator revealed that from their knowledge the residents Doctor / provider assist the residents with choosing a home health agency. The facility does not have any agreements or partnerships with any home health agencies. The residents and their families always have the option to choose their preferred home health agency. The facility has never pressured, directed or forced a resident to choose a specific home health agency. File review revealed that eight (8) residents are currently receiving home health services from a variety of different home health agencies. Interview with a family member of a resident on home health revealed that they were assisted by their physician on different home health agencies to choose from. They were not directed to choose a specific home health agency by the facility. Interview with a Doctors office of a resident on home health revealed that residents who are on home health need a referral from a medical professional based on the residents condition and needs. Once a referral is made the health care provider will suggest specific agencies based on insurance. Residents are typically provided options that are covered by their insurance, and geographic location. The choice is the residents and their family. Once the resident and family make a choice, the chosen agency assesses whether they can meet the residents needs. The choice is on the Resident and family. Report continued on LIC 9099-C PAGE 3... (PAGE 3) Report continued from LIC 9099-C PAGE 2... Resident interviews revealed that they are assisted by their physician / provider with choosing a home health agency . The facility has never pressured, directed or forced them to choose a specific home health agency. Interview with staff revealed that the facility currently has four (4) different home health agencies providing services to their residents. The agencies are referred to the residents by their physician. From their knowledge the facility does not have any agreements or partnerships with any home health agencies. The residents and their families always have the option to choose their preferred home health agency. The facility has never pressured, directed or forced a resident to choose a specific home health agency. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Facility does not allow residents to choose their home health agency is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report provided.the state’s words, verbatim · CDSS document, Sep 5, 2025 · control 29-AS-20250902163808

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Erica Mosley conducted a Case Management - Deficiencies visit due to a deficiency observed during a complaint investigation. At 10:10 a.m. during a complaint investigation LPA Mosley was informed by facility staff and acting Administrator that they have been Administrator since 09/01/2025. Upon review of the Guardian Background Check System the Administrator was observed to have fingerprint clearance but was not associated to the facility. LPA informed the Administrator that employees must obtain a fingerprint clearance and be associated to the facility prior to working, residing or volunteering in a licensed facility. LPA informed the Administrator that a civil penalty in the amount of 500$ (1 Employee x 100$/day x 5 days [maximum of 5 days] = $500) will be assessed on today’s date (09/05/2025) for not having submitted a criminal record clearance transfer request. At the time of the visit the Administrator provided the LPA with the required documentation and was associated to the facility. Plan of Correction (POC) cleared on site. Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil penalties were issued in the amount of $500. Administrator was informed that failure to correct deficiencies may result in additional civil penalties. Exit interview conducted, report issued, and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 5, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(3) · Plan of correction due date: Sep 5, 2025

87355(e)(3) All individuals subject to a criminal record review... shall prior to working, ...(3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as the Administrator had fingerprint clearance but was not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 5, 2025

Plan of correction: Administrator submitted the required documentation to LPA and was associated at the time of the visit. POC Cleared on site.

Allegation investigated: Staff do not safeguard resident's personal belongings.

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. Also participating in today's visit was Aaron Feingold, Administrative Assistant. The reason for today's visit was provided. On today's visit, LPA Yee interviewed the Administrator at 1:18pm, Staff #1 at 3:30pm, Staff #2 at 3:37pm, Resident #1 at 2:43pm and Witness #1 at 1:44pm. The following documents were requested from Resident #1's file - Identification and Emergency Information, Preplacement Appraisal Information, Resident Appraisal, Appraisal/Needs and Services Plan, Physicians Report and Residence and Service Agreement. Also obtained was a copy of the LIC624 for an incident that occurred on 2/25/25. Resident #1 indicated that a frozen chicken leg and a water bottle had been removed from the refrigerator. Staff helped resident look for the missing items and observed that the refrigerator had chicken and water. Resident #1 stated that they continued on LIC9099-C Unsubstantiated were missing a chicken leg and a bottle of water. Per interview conducted with Resident #1, they were asked why they believed that staff took the frozen chicken leg, bottle of water and all their compression socks. Resident #1 stated that they did not say that staff took those items. Per Resident #1, anyone could have taken it. They do not know who took them. They were also missing Social Security and IRS paperwork. Per Resident #1, they reported the theft to the police and the police helped them look for the paperwork and were able to locate the cover sheets for the social security in the night stand drawer. Per Resident #1, the paperwork was kept in their suitcase. Resident #1 refused to allow staff to help them locate the missing items when LPA Yee offered the staff's services. Per Resident #1, the caregivers and housekeepers all have keys to their room. Per Resident #1, no one should be coming into their room. Per resident, they used to leave their sliding glass door to the balcony ajar in the morning. Resident #1 also indicated that their room would be full of smelly gas like smoke in the early morning and does not know where it was coming from. It could be coming from the air vents or from the outside because the sliding glass door was ajar. Resident #1 indicated that they recognize cigarette smoke but couldn't identify the smelly smoky gas in their room. Per interviews conducted with Staff, they cannot imagine how anyone could take anything from Resident #1's room. The resident is very anxious and never leaves the room and staff do not enter the resident's room when they are not there. Resident #1 does not go down to the dining room and does not participate in any activities. Resident #1 orders food twice a week from InstaCart. Resident #1, does not allow anyone in their room. During the interview conducted with Resident #1 in their room, LPA Yee was shown a gallon sized plastic zip log bag with multiple pairs of socks inside and a sandwich sized zip lock bag supposedly containing drug paraphernalia that was wrapped in a facial tissue. These bags were given to staff at the end of the interview. Resident #1 claimed that the socks were not theirs and the sandwich bag did not contain any drug paraphernalia when the contents were emptied on to a towel. It contained about 5 sandwich bags and the cap of a makeup pencil. Interviews conducted with the Staff #1 and Staff #2, they deny that they took anything from the resident or threw any paperwork out by accident. Per the Administrator, Resident #1 never reported to her that their compression socks and paperwork was missing. She is only aware that Resident #1 was missing a frozen piece of uncooked chicken because the police called her about the missing chicken. At this time there is insufficient evidence to support the allegation that the staff do not safeguard the resident's personal belongings. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated at this time. Exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 29-AS-20250819160550

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced Case Management inspection regarding a self-reported Death Report (LIC 624) received. LPA met with facility Administrator Evelina Papazyan at 09:40 AM and explained the reason for the visit. On 06/19/2025, Community Care Licensing (CCL) received a self-reported Death Report (LIC 624) pertaining to the death of Resident #1 (R1) which occurred on 06/18/2025. During today’s visit between 09:40 AM and 11:30 AM interviewed the Administrator, conducted a file review for one (1) resident, and obtained copies of pertinent documentation. No deficiencies were observed during today’s inspection. If warranted upon further review of information and documentation received, a LPA will return to conduct further investigation. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 20, 2025

Allegation investigated: Facility staff are not meeting residents toileting needs

Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to continue the investigation for the above allegation and met with Evelina Papazyan, Administrator. The reason for today's visit was explained. On 2/21/25, LPA Yee conducted an investigation into two separate complaints on today's visit. interviews with the Administrator at 10:09am, Staff #1 at 11:21am, Staff #2 at 12:47pm, Staff #3 at 1:04pm, Resident #1 at 1:24pm, Resident #2 at 1:48pm, Resident #3 at 2:23pm and Resident #4 at 2:49pm and Resident #5 at 5:05pm. Due to time constraints, the findings for both complaints investigated on today's visit will be rendered on a return visit. Further investigation is needed at this time. Exit interview was conducted and a copy of this report was provided at the conclusion of the visit. continued on LIC9099-C Unsubstantiated On today's visit, LPA Yee conducted a joint interview with the Administrator at 11:05am and Staff #1 at 11:08am to clarify conflicting information received from previous visit and Staff #6 at 3:12pm. Per investigation into the allegation that Facility staff are not meeting residents toileting needs, on 2/16/25 Resident #5 called the front desk for assistance getting up from the toilet using their cell phone around 3:55pm. They waited about 30 minutes and staff still did not show up. Resident #5 cleaned themselves and got back in their wheelchair. Per Resident #5, they called the front desk again around 4:30pm for assistance and told Staff #5 that no one showed up. Per telephone interview with Staff #5, they contacted Staff #6 via walkie talkie to let them know that Resident #5 needed assistance on the initial call for assistance. Per Staff #5, the resident did not indicate what kind of assistance was needed. On the second call to Staff #5 for assistance, Resident #5 ended the call by saying "never mind." Per interview with Staff #6, they did respond to Resident #5's request for assistance around 3 something. Video with date and time stamp provided shows Staff #6 entering the room at 16:51pm on 2/16/25. The time on the camera had not been changed from the daylight saving change in the fall of 2024. Per Staff #6, they helped the Resident change into their night gown because the resident indicated that they were not going down for dinner because a family member had brought them salmon for dinner. Per Staff #6, Resident #5 was not left on the toilet, never. Resident does not require assistance with toileting and does not call for assistance with toileting. Resident #5's calls for assistance are mainly to get changed into a night gown and to remove trash from the room. Resident can't stand having trash on the bed. Per Staff #6, it has been a long time since Resident #5 has requested help going to the bathroom. Conflicting information was obtained from the interviews conducted with the resident and staff. Per the investigation conducted, there is insufficient evidence to support the allegation that facility staff are not meeting residents toileting needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 16, 2025 · control 29-AS-20250220104222

Allegation investigated: . Staff does not ensure residents personal belongings are safely secured

Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to continue the investigation of the above allegation and met with Evelina Papazyan, Administrator. The reason for today's visit was explained. On 2/21/25, Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. The reason for today's visit was provided. On the visit conducted on 2/21/25, LPA Yee conducted an investigation into two separate complaints on today's visit. interviews with the Administrator at 10:09am, Staff #1 at 11:21am, Staff #2 at 12:47pm, Staff #3 at 1:04pm and Resident #1 at 1:24pm, Resident #2 at 1:48pm, Resident #3 at 2:23pm and continued on LIC9099-C Unsubstantiated Page 2. Resident #4 at 2:49pm. Due to time constraints, the findings for both complaints investigated on today's visit will be rendered on a return visit. Further investigation is needed at this time. Exit interview was conducted and a copy of this report was provided. On today's visit, LPA Yee conducted a joint interview with the Administrator at 11:05am and Staff #1 at 11:08am to clarify conflicting information obtained from previous interviews and Staff #8 at 12:01pm. Per information obtained from interviews conducted regarding the allegation that staff does not ensure residents personal belongings are safely secured, the Administrator is not aware of any facility wide incidents of theft. The only incident that was brought to her attention was in back in November 2024. Resident #4 had come to her office and informed the Administrator that they were missing money in the amount of $230 from their room. Per interview with Resident #4, resident also admitted to staff and LPA Yee that they would roll up money in a sock and hide it somewhere in the room and couldn't find it or remember where it was hidden. Resident also indicated that a family member had given them $300 as a gift to have their hair done. $20 of that money was given to their offspring and the amount stolen or misplaced was $280, which is different from what was told to the Administrator. Resident #4 stated that they rolled money in a sock and placed it in their knitting box but now it is not there. Resident #4 also indicated that 10 of the 12 porcelain tree ornaments of faces of little women, purchased from a garage sale was in the room one day and gone the next day or two. Per the Administrator, the missing ornaments were never reported to her. When the missing money was reported to the Administrator, Staff #8 was sent to the room to assist the resident in finding the money but it was not found. The Administrator also offered to call the police to file a theft report but, Resident #4 informed her that they would speak with their offspring about it first. On 11/20/24, two days later, the Administrator met with the offspring to discuss the missing money and also offered to file a police report and it was refused. Per the offspring, they would go up to the resident's room after the office meeting and search for it since the resident has a known tendency to hide money and various things and had a difficult time finding it again. A few days later the offspring contacted the front office staff to relay a message to the Administrator that they did not want a police report filed and that the matter was resolved and not to approach Resident #1. Per the Administrator, they dropped the matter. Per the offspring, they did not have a meeting Page 3 with the Administrator. Resident#4 was asked by LPA Yee why they believe that staff was coming into their room at night and the response was that their bedroom door is kept locked and a key is needed for entry. Staff have the room keys. Per Interviews conducted with staff, they all deny that the staff are stealing any residents money and are unaware of any theft going on at the facility. . The staff who work the night shift are very long time employees and there aren't any strangers wandering around in the facility at night. Visitors are required to sign in and out. Randomly selected Residents from all 3 floors were interviewed and they deny having any knowledge of staff stealing residents belongings and they do not have anything missing. Per Resident #1, the laundry is usually what is missing because they are misplaced not stolen. Per Resident #2, they know about the theft of Resident #4's money and porcelain ornaments because Resident #4 told them about it and they believe them. During the investigation, LPA Yee was not able to locate anyone else besides Resident #4 who was missing money and the porcelain ornaments. By own admission Resident #4 hides their money and their belongings for safe keeping and has a difficult time remembering where they hid or put it. During this visit, Resident #4 was observed to have misplaced their wallet and claimed it was in the Administrator's office. Staff found the wallet in the resident's room. Based on information obtained during the investigation, LPA Yee was not able to find sufficient evidence to support the allegation that Staff does not ensure residents personal belongings are safely secured. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 16, 2025 · control 29-AS-20250218093203

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit at 9:55 a.m. Upon arrival LPA was greeted by front desk receptionist and explained the reason for the visit. LPA met with Administrator, Evelina Papzyan and the reason for the visit was explained. At approx. 10:00 a.m. LPA Mosley along with Administrator conducted a tour of the physical plant to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was noted: Facility is a three -story residential building consisting of 30 bedrooms, a commercial kitchen, dining room, television room, lounge and a staff break room on the first floor. The second floor has 36 bedrooms, dining room, library and television room. 16 bedrooms out of the 36 bedrooms are designated for the dementia / memory care unit. The third floor has 37 bedrooms. The facility is fire cleared for 63 Ambulatory, 112 Non-ambulatory and 20 bedridden residents. Delayed egress is approved for the dementia unit. Hospice waiver for 4. LPA observed fire extinguishers throughout the facility, which were fully charged and last serviced on 1/11/2024. The Administrator provided a fire alarm testing and inspection report done on 12/04/2023 where all smoke alarms and carbon monoxide detectors were tested and functioned properly. The facility has their upcoming inspection scheduled for this week. The last emergency disaster drill took place on 09/30/2024 and are conducted quarterly. LPA observed all required postings adjacent to the entrance area. The facility serves residents with dementia, the auditory alarms on the exit doors of the dementia /memory unit were tested and functioned properly at the time of visit. Activities observed on both units. (PAGE 1) Report Continued on LIC 809C PAGE 2... (PAGE 2) Report Continued from LIC 809 PAGE 1... Kitchen: During the facility tour, at 10:09 am the kitchen appeared clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Snacks and beverages are available for residents in the dining area. Knives are stored and inaccessible to residents. Refrigerator and food pantry were checked for proper labels and expiration dates. Bedrooms: During today’s visit from approx. 10:00 am to 10:51am, LPA observed nine (9) randomly selected resident bedrooms, of which six (6) in Assisted Living and three (3) in Memory Care. First floor: RM#109, RM#111, RM#114, Second floor: RM# 204, RM#206, RM# 215, RM# 226, RM#230, and Third floor RM# 313. The resident bedrooms were properly furnished with at least one chair, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Restrooms: The resident restrooms appeared clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. The hot water measured between 106.0 – 118.9 degrees Fahrenheit all within the required range. Common Areas: These included the libraries, activity rooms, television rooms, and dining areas in assisted living and memory care units. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Fireplaces in the common area are all non- functional. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Parking is available for residents and visitors. Infection Control / Emergency disaster planning: During today’s visit LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate. An adequate amount of emergency supplies including food and water is stored in a storage room adjacent to the kitchen area. Report Continued on LIC 809C PAGE 3... (PAGE 3) Report Continued from LIC 809C PAGE 2... MEDICATION AUDIT: LPA conducted a medication audit on five (5) randomly selected residents at approx. 2:45 p.m., The medications are centrally stored in the medication room located on the 1st floor. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. No errors observed during review. RECORDS: Resident Records and Personnel records were reviewed from approx. 10:51 am – 1:30 pm. LPA Mosley reviewed Resident Records at approx. 10:51 a.m. Eight (8) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. At approx. 12:15 p.m. Eight (8) personnel files including the Administrators file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order at the time of the visit. LPA obtained the following documents during the visit LIC 500 Staff roster, Resident roster, and current liability insurance. INTERVIEWS: From approx. 3:00 p.m. - 4:45 p.m LPA conducted eight (8) staff interviews and eight (8) resident interviews during the visit. No concerns noted at this time. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 2, 2024

Allegation investigated: Food Service - food poisoning

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced subsequent complaint visit to deliver the findings of the above allegation and met with Evelina Papazyan, Administrator. The reason for the visit was provided. LPA Yee conducted an initial unannounced complaint visit on 4/9/24. On the initial visit, LPA Yee conducted an interview with Evelina Papazyan, Administrator at 1:47pm, Staff #3 at 4:09pm, Resident #1 at 2:59pm, reviewed and obtained copies of Resident #1's file at 1:35pm and other facility documents throughout the visit. A tour of the kitchen was conducted at 3:50pm to observe the Ecolab chemical dish washing system in place to wash and disinfect the dishes, utensils, pots and pans. Per information received from the interviews conducted, Resident #1 was taken to the hospital on 2/23/24 due to persistent diarrhea and vomiting. The resident believed that they have food poisoning Unsubstantiated due to the dirty pots and pans in the facility. Per review of hospital documents, Resident was seen by the doctor for diarrhea and Enteritis (Bowel condition). Various lab tests were completed, including a CT scan of the abdomen and pelvis during this visit. Prescription for antibiotics, Cefpodoxime 200 mg and Metronidazole 500 mg, were prescribe for diarrhea and pneumonia at time of discharge. Per review of the discharge reports, one of the impressions noted by the reviewing doctor reveals that there “is fluid in the small bowel, colon, and rectum, consistent with enterocolitis/diarrhea” Diarrhea and vomiting are 2 of the common symptoms of enterocolitis. Enterocolitis may be caused by various infections including food poisoning. The meals consumed by Resident #1, were also consumed by other residents and no complaints of food poisoning were received. Per interviews conducted with the Administrator and Staff #3, they have not received any complaints from the residents of food poisoning or aware of anyone who had food poisoning. Residents have had symptoms of diarrhea and vomiting at the facility when they had a Covid outbreak. It was not due to food poisoning. The Covid outbreak was reported to the Department on 2/12/24. The kitchen was also toured together with the Administrator. It was observed that the facility has a Ecolab chemical dish washing system in place to wash and disinfect the dishes, utensils, pots and pans. Per information provided, the dishes, utensils, pots and pans are first pre-washed with chemicals, washed and then disinfected. Kitchen staff are trained to use the system to ensure that everything is washed and sanitized correctly. Based on the interviews and documents reviewed during the investigation, there is insufficient evidence to support the allegation that the resident had food poisoning as a result of the dirty pots and pans used for cooking, therefore the allegation is unsubstantiated at this time. No deficiencies were cited on today's visit. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 27, 2024 · control 29-AS-20240405104805

Allegation investigated: Facility illegally evicted a resident in care.

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. The reason for today's was explained. LPA Yee conducted interviews with the Administrator at 10:31am and 12:18pm, Resident #1 at 12:01pm, Resident #2 at 11:36am and Staff #1 at 12:37pm. Per information received from interviews conducted with the Administrator and Staff #1 on today's visit, Resident #1 was never served a 30 day eviction notice and there has been no discussion with Resident #1 about eviction. Per interview conducted with Resident #1, they confirmed that they have not been served a 30 day eviction letter. LPA asked Resident #1 why they believed that they were being evicted. LPA was told by Resident #1 that the Administrator told them that they were going to be evicted and they would given a Unsubstantiated 30 day eviction notice when they were called into the office to discuss the soup incident that occurred in the dining room. Resident #1 had thrown soup at Resident #2 on 7/20/24. The Administrator had concerns as this was the second time that Resident #1 had thrown a hot liquid at Resident #2 . On both occasions, law enforcement had been called and each time Resident #2 did not want to press charges. The Administrator denies that the subject of eviction was ever discussed with Resident #1 during the meeting conducted on 7/22/24 to address the soup incident. Staff #1 who usually sits in on office meetings with residents, also confirmed that eviction was not discussed during the meeting. Interviews conducted reveal that Resident #1, on their own, voluntarily contacted their placement agency in March 2024 and the placement agency is in the process of finding relocation sites for Resident #1, due to relationship issues going on at the facility. Based on information received from interviews conducted, there is insufficient evidence to support the above allegation that facility illegally evicted a resident in care, therefore the above allegation is unsubstantiated. Exit interview was conducted.the state’s words, verbatim · CDSS document, Aug 1, 2024 · control 29-AS-20240726130820

Allegation investigated: . Staff emotionally abused resident 2. Staff violated resident's personal rights

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and met with Evelina Papazyan, Administrator. The reason for today's visit was explained. On today's visit, LPA Yee conducted interviews with the Administrator at 10:22am, Resident #2 at 11:12am, Resident #1 at 11:44am, Staff #1 at 12:31pm and Staff #2 at 1:00pm. Facility documents were collected throughout the visit. Per interviews conducted, Resident #1 had been hospitalized for a respiratory condition and had returned to the facility on 6/1/24. On 6/2/24, around 7pm, a woman showed up at the facility and identified herself at the front desk as a nurse with the Sherman Oaks Hospital Home Health. She was at the facility to see Resident #1. Staff #1 was confused because Resident #1 was already receiving home health services with Unsubstantiated another home health agency. Staff #1 advised the woman that they would have to call the Administrator for clarification and the woman told Staff #1 that she could speak with the Administrator, but she was going to see the Resident #1 and walked away. Per the woman, Resident #1 was not happy with her current home health agency and that they did nothing for Resident #1. Per Staff #1, the woman had already called a few minutes earlier while she was looking for parking and spoken with a co-worker and had already obtained Resident #1's room number. Per interview with Resident #1 and Resident #2, roommate, they were confused. The woman said she was from Sherman Oaks Hospital and they did not know why she was there. Resident #1 thought they did something wrong. Per Resident #1, the woman asked about showers and the woman was told that the facility charged $400 a month for showers and the woman advised that the showers would be free with her agency, the woman asked where they obtained their medications, laundry services and many other questions. Per Resident #1, they were already receiving home health services and was very happy with the current home health agency. Per Resident #1, they were lead to believe that the women was collecting information for the hospital since a follow up visit was pending at the hospital. Per Resident #1, they did not request home health services. Per Resident#1, the woman had her sign documents handed to her during the room visit but no explanation was given. Per Staff #1, the Administrator was contacted and the phone was given to the woman during her visit to Resident#1's room. Per the Administrator, she had no idea what this visit was all about since Resident #1 never informed her that she was unhappy with the current home health agency or no new orders were received. She did not prevent the visit as Resident #1 is allowed to chose own home health agency and asked the woman to call her the following day to discuss the matter. On 6/5/24, Resident #1, who was still confused, approached the Administrator and asked her why the woman who spoke with her and had her sign documents since she never requested a new home health agency. The Administrator advised Resident #1 that they could call the agency together to straighten out things. The call was made utilizing the speaker phone from the Administrator's office. The Administrator informed the woman for the reason for the call. Resident #1 indicated that they were happy with the current services and the woman went off on the Administrator and loudly accused her of manipulating Resident #1. The woman indicated that the resident was not happy with the current home health services and that the resident had the right to choose their own home health agency. A gentleman also loudly joined in the telephone conversation. Per the Administrator, she was not allowed to say anything. Per Resident #1, they did not feel emotionally abused, intimidated or felt that their personal rights were being violated by the Administrator. They felt supported by the Administrator who was looking out for them. It was the woman and gentleman who were the aggressors. The Administrator did not yell. This was also confirmed by Staff #2. Per Resident #1, this is the first place that she feels like she belongs. Based on the interviews conducted, there was insufficient evidence to support the allegations that the staff emotionally abused resident and staff violated the resident's personal rights. Therefore the findings for both the allegations are unsubstantiated. Exit interview was conducted.the state’s words, verbatim · CDSS document, Jun 11, 2024 · control 29-AS-20240606161017

Allegation investigated: Facility staff do not provide a safe environment for resident in care

LIcensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator and the reason for today's visit was explained On today's visit, LPA Yee interviewed the Administrator at 10:49am, Resident #1 at 1:04pm, Resident #2 at 12:04pm, Resident #3 at 11:46am, Resident #4 at 12:42pm, Resident #5 at 2:02pm , Resident #6 at 2:40pm and Staff #1 at 3:04pm.. Resident #1 and Resident #2's files were reviewed at 11:25am and copies of the files were requested at 11:40am. Per information received from the interviews conducted during today's visit, Resident #1(R1)and Resident #2(R2) have been dating for a couple of years. R2 broke up with R1 on 1/10/24 and the breakup was not received well by R1. R1 would attempt to barge into R2's room or enter through the sliding glass door Unsubstantiated located on the patio and sleep in R2's bed. R1 was very possessive of R2. R1 would be verbally abusive with R2 and would send vulgar and threatening text messages and made multiple calls to R2's cell phone and R2 would turn off the phone. Around this time, R1 also threw hot coffee on R2's face because they were angry that R2 was ignoring them. R2's family were notified and the police were called. The police spoke with R1 and staff and did not do anything as no crime was committed. The Administrator spoke with R1 about this incident and outpatient mental health services were arranged. R1 attended the mental health services for a couple of months and then R1 decided to quit. Administrator was told that R1 was not going to attend anymore and preferred to see their own doctor. R1 also saw the facility doctor a few times and quit. In early April 2024, R1 and R2 got back together for a few weeks and R2 broke up again with R1 on 5/1/24. The reason for both the breakups were due to R2's health and not being able perform and fulfill the duties of the relationship. R2, who is 83 years old, is fourteen years older than R1. R1 wanted to desperately marry R2 and at one point in their relationship when R2 was hospitalized and sedated, R1 brought a rabbi to the hospital to marry them. Per information provided, R2 is still legally married. About a week prior to the second break up, R2 spoke with the Administrator and asked her to speak with R1. R2 did not want to be in a relationship with R1 and wanted to be left alone. Before the Administrator could speak with R1, R2 broke up with R1 on 5/1/24. On 5/3/24, without the Administrator's knowledge, R1 went to court to file a restraining order on R2 alleging that R2 had squeezed R1's head and neck and now is afraid. The restraining order was denied. The police was also called by R1. Per information provided, when the police asked about the head squeezing incident R1 was inconsistent. R1 could not remember when it happened, where it happened or provide the details of the incident. Nothing was done by the police. R1 was simply told to stay away from R2. Per LPA Yee's interview with R1, the resident could not tell LPA Yee where the head and neck squeezing incident occurred. Per R1, the incident happened about a week ago but does not remember the day it happened, where it happened and time of day it happened or what lead up to the incident. Upon further questioning R1 stated that maybe it happened upstairs while they were sleeping in their room at night. R1 does not know how R2 got in the room and does not remember if their room was locked. R1 was getting upset with LPA Yee, saying that LPA does not believe them. Per R1, they have a court hearing on 5/28/24 and stated that they have no evidence or witness to the alleged incident and is relying on the court to take their word because they are honest. Per interview with R2, they never squeezed R1's neck or head. Per interviews conducted, R1 is the aggressor. R1 has been asking residents to go to court on 5/28/24 to testify against R2 but everyone has indicated that they did not see anything. Resident #4 who refused to get involved received nasty text message from R1. Per Staff interviewed, they have always stepped in when R1 has been nasty to R2 and addressing other residents concerns when R1 gets angry at them for refusing to go to court with them. R1 has accused them of not enforcing the restraining order that was denied. R1 states that the Administrator called them a vulgar name and staff hates them. Based on interviews and record review, there is insufficient evidence to support the claim that staff failed to provide a safe environment to the resident in care, therefore the allegation is deemed unsubstantiated at this time. No deficiencies were cited on today's visit. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 21, 2024 · control 29-AS-20240514085611

Allegation investigated: Staff will not allow resident to return back to the facility

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and initially met with Indra Lopez. Evelina Papazyan, Administrator was contacted and she arrived a little later to conduct the visit. The reason for today's visit was provided. On today's visit, in person interviews were conducted with the Administrator at 10:01am, Indra Lopez, Office Staff, at 10:31am and telephone interviews were conducted with Resident #1(R1) at 10:41am and Witness #1(W1) at 11:08am. Copies of documents for R1 was reviewed and obtained during the visit. Per information received from the interviews conducted, Resident#1's doctor discharged the resident on 12/12/23 for the medical condition that the resident was hospitalized for on 12/2/23. However, during the hospital stay, Resident #1 was diagnosed with Covid-19 on 12/8/23. Resident #1 had a high fever and was Unsubstantiated placed in isolation. When the discharge paperwork was written up on 12/12/23, R1 contacted the Administrator to advise her that R1 was going to be discharged that day(12/12/23). Witness #1 also contacted the Administrator about R1's discharge. Per discussion between the Administrator and Witness #1, the resident would be out of the 5 day isolation period on 12/14/23 per physician's note. The Administrator indicated that Resident #1 could return once the isolation period was completed. No one told R1 or W1 that resident could not return to the facility. Also, per facility staff interviews, hospital staff made references to dates of return, the facility did not. The return date of 12/19/23 was never mentioned by facility staff. Witness #1 relayed the date that the isolation would be completed to Resident #1 and per Witness #1, Resident #1 was okay with it. Resident #1 was also being indecisive. Resident#1 would tell the hospital staff that they wanted leave and than change their mind. This went back and forth with the hospital staff. The facility staff was also getting calls from different nurses about the discharge. Per interview with Witness #1, a skill nursing facility that accepts Covid-19 patients was located today and resident could be discharged today to the nursing home if R1 wanted. This option would allow R1 to stay longer if the stay needed to be extended since R1 is indicating continued vomiting and excruciating pain. Per information provided by Witness #1, R1 was advised of the availability at the skilled nursing facility but R1 refused be discharged to the nursing home today(12/13/23). Per Witness #1, the only option available to R1 now is to wait out the isolation period so R1 could return to facility if there are no complications. Per interview with Resident #1, resident was made aware on 12/12/23 that the isolation period was over on 12/14/23 but the hospital case worker indicated that the isolation period was until 12/19/23. Per Witness #1, this was due to mis-communication. Based on the information received through the interviews conducted on today's visit, the finding for the above allegation is unsubstantiated. Exit interview was conducted.the state’s words, verbatim · CDSS document, Dec 13, 2023 · control 29-AS-20231212143123

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Yee conducted a subsequent required Annual Inspection visit to complete citations for deficiencies noted on the visit conducted on 12/7/23. The review of the CARE Inspection Tool was completed on the 12/7/23 visit and was not utilized on today's visit. LPA Yee met with Evelina Papazyan, Administrator and the reason for today's visit was provided. An initial required Annual Inspection was initiated on 12/6/23 and 9 domains noted on the initial LIC809 were reviewed and no citations were issued. A subsequent Annual Inspection was conducted on 12/7/23 and the last 3 domains noted on the subsequent LIC809 report were reviewed and a tour of the physical plant, inside and outside, was also conducted. Deficiencies were observed on the subsequent visit and due to time constraints, LPA Yee was only able to cite for Type A issues. Today's visit is for the purpose of issuing citations not completed on the 12/7/23 visit. Deficiencies observed during the previous two visits are being 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, Dec 13, 2023

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Christine Yee conducted a subsequent visit to continue the required Annual Inspection initiated on 12/6/23 using the complete CARE Inspection Tool. LPA Yee conducted the visit with Evelina Papazyan, Administrator. On today's visit LPA Yee reviewed the following domains: Physical Plant/Environmental Safety, Disaster Preparedness and Residents with Special Health Needs. A tour of the physical plant, inside and outside was also conducted. The kitchen, dining room, lounge, television rooms, libraries were inspected and the following resident bedrooms were inspected: 104, 111, 114, 120, 126, 201, 206, 213, 220, 303, 310, 317, 332 and rooms in the Dementia Unit - 221, 226, 231, 236. Per tour of the physical plan the following were observed: the Kitchen had the appropriate equipment, cleaning solutions were stored under the table located by the kitchen sink. Sufficient perishables and non-perishable foods were observed, individual bottles of water were observed in the room used to store the emergency food. The dining room has plenty of sitting for all the residents to eat in one sitting. The lounge on the first floor has sufficient seating, The television room on the first floor and in memory care have plenty seating for residents. All the bedrooms inspected have the required bed, chair, lamp, night stand, closet and dresser except for rooms number 231 and room #236 are missing the dresser. Residents are using the desk drawers as dressers. Beds were observed with linens that the residents have chosen that they want to use. Extra linens were observed in the linen closet Blinds for the windows and sliding glass doors in bedrooms #104, #111, #126, #220, #221, 226 were observed missing slates or were broken. each bedroom has its own bathroom equipped with a shower with a shower curtain, grab bars, a shower chair, non-skid mat, a toilet and a sink. Water temperature was tested in the rooms that were inspected and the water temperature was within 105 -120 degrees Fahrenheit except for the following rooms - bedroom #201 - 121.8, bedroom # 206 - 121.4 and bedroom #236 - 93.2 degrees Fahrenheit Carbon monoxide detector were observed in the dining room, lounge, the snack room and in resident bedrooms. Smoke detectors located in all the resident bedrooms were not tested since the facility was just inspected by the vendor contracted by the fire department on 12/4/23 and the facility passed inspection. Copy of the report was obtained. Fire extinguishers last serviced on 3/16/23 were observed on each floor. Located on the first floor are 5 fire extinguishers, including the kitchen, five on the second floor and 4 on the third floor. First Aid Kit and first aid manual was observed. The door on bedroom #120 was observed warped and needs repair. Ceiling in bedroom #201 observed with chipped paint and needs repair due to water damage. The floor of the balcony outside the second floor library and the patio chair needs repair. The carpeting stored in the courtyard needs to be removed, The facility needs general cleaning and all discarded items stored by the dumpsters in the parking lot need to be removed. all three dumpsters in the parking lot were observed left open and needs to be tightly sealed. Due to time constraints, only Type A citations were issued on today's visit. A return visit will be conducted to issue Type B citations observed on today's visit Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted, Appeals Rights discussed and a copy was provided.the state’s words, verbatim · CDSS document, Dec 7, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection visit and used the complete CARE Inspection Tool. LPA Yee met with Evelina Papazyan, Administrator and the reason for today's visit was explained. The facility is a 3 storey residential building consisting of 30 bedrooms, a commercial kitchen, dining room, television room, lounge and a staff break room on the first floor. The second floor has 35 bedrooms, dining room, library and television room. 16 bedrooms out of the 35 bedrooms are designated for the dementia unit. The third floor has 36 bedrooms. The facility is fire cleared for 63 Ambulatory, 112 Non-ambulatory and 20 bedridden residents. Delayed egress is approved for the dementia unit. The following domains of the CARE Inspection Tool were reviewed on today's visit: Infection Control, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Records-Incident Reports, Resident Rights/Information, Planned Activities, Food Service, Incidental Medical and Dental. LPA Yee also reviewed the facility's Infection Control Plan, Emergency Disaster Plan, ten (10) resident files and seven (7) staff files. Per review of the nine (9)domains, 10 resident files and 7 staff files it was observed that all the required documents were in the residents and staff files and the hand washing procedures and requirements of each domain were being adhered to by the facility. The remaining three (3) domains: Physical Plant/Environmental Safety, Disaster Preparedness and Residents with Special Health Needs will be reviewed on a return visit. No citations were issued on today's visit. Exit interview was conducted with Evelina Papazyan.the state’s words, verbatim · CDSS document, Dec 6, 2023

Allegation investigated: . Staff will not allow resident to have visits/calls from family members

Licensing Program Analyst (LPA) conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. The reason for today's visit was explained. On today's visit, LPA Yee interviewed Evelina Papazyan at 10:01am, Staff #1 at 10:56am, Staff #2 at 12:25pm, Resident #1 at 10:28am and a telephone interview with family member at 11:43am. Copies of facility documents were requested at 10:23am. Per information obtained from interviews, Resident #1 was placed at the facility by the resident's oldest daughter in March 2023. In early August 2023, the other two daughters of Resident #1and their children flew in from Hawaii and visited with Resident #1 and had an ejnjoyable time. When the oldest daughter found out about the visit, she hand delivered a self drafted letter, dated August 13, 2023, to 3 staff continued on LIC9099-C Unsubstantiated stating that effective immediately Resident #1 was not allowed to have any visitors except the persons that were named in the letter. The persons named in the letter are, the names of the resident's oldest daughter, a granddaughter, 2 grandsons and a family friend. The letter also had the following restrictions: that Resident #1's mail was to be held in a secure place until it was picked up by Resident #1's oldest daughter. the facility was also told not to accept or transfer any calls received from anyone except the persons named on the list and the she is to be notified immediately Also if anyone visits or calls and states that "they were given permission by..." it should not be accepted with any exception and she is to be notified immediately Included with the letter was a copy of the Power of Attorney. Per interview with the Administrator, the oldest daughter was told that the letter she drafted with the restrictions and the Power of Attorney documents were not enforceable and were filed. Staff were instructed that if any of Resident #1's family questioned them, they were told to refer them to the Administrator. On 9/26/23, office staff received call from one of the daughter's of Resident #1 and she was very upset and was yelling at staff because she was told she and the rest of the family could not visit or call Resident #1. Per the Administrator, she nor any of the staff ever told the daughter or any of the family that they could not visit or call mom. This was confirmed by Staff #1 and Staff #2. The children of Resident #1 are currently on bad terms and are involving the facility in their family disputes which the facility is choosing to stay out off and ensuring Resident #1's personal rights are protected. Per telephone interview with the family member at 11:43am, the family member was specifically asked if the Administrator or any staff told them that they could not call or visit Resident #1 and the response was a firm no. The staff were very nice. The sister is the one telling them that they cannot visit or call Resident #1 by providing the documents to the facility to enforce. Per the family member they were not yelling at the staff, They were upset and talked loud. Per information received on today's visit, there is insufficient evidence to support the above allegation. Therefore, the findings of the above allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of the report was given.the state’s words, verbatim · CDSS document, Oct 3, 2023 · control 29-AS-20230925123516