Dignity First Assisted Living Facility

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced Case Management visit to the facility and was greeted by Owner Kevork Halladjian and the purpose of the visit was explained. The reason for the visit is to rescind the report issued on 5/8/26 in which the deficiency issued 1569.52(c) shall be changed to a better fitting citation 87507(g)(5)(A) Case Management visit was conducted on 5/8/26 and included the following: The reason for the visit is on 12/18/2025 during the course of a complaint investigation # 28-AS-20251212145452 the following was observed: LPA reviewed the Admission Agreement for Resident R1 and listed under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances. Deficiency to be issued Health and Safety Code 1569.652 (c) on the 809 D page. Facility needs to update or add additional information to the refund policy. Deficiency cited on the 809D. Exit interview conducted and copy provided.the state’s words, verbatim · CDSS document, Jun 19, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(A) · Plan of correction due date: Mar 15, 2026

Admission Agreement Admission agreements shall specify the following: Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement is not met as evidenced by: Licensee has listed on the Admission Agreement for Resident R1 under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Jun 19, 2026

Plan of correction: Licensee to update or add additional information to the refund policy on the Admission Agreement and send proof to Licensing by POC due date. Deficiency cleared on 5/13/26.

Type of visit: Case Management - Deficiencies

LPA Glenn Trueman made an unannounced Case Management visit to the facility and was greeted by Owner Kevork Halladjian and the purpose of the visit was explained. The reason for the visit is to rescind the report issued on 5/8/26 in which the deficiency issued 1569.52(c) shall be changed to a better fitting citation 87507(g)(5)(A) Case Management visit was conducted on 5/8/26 and included the following: The reason for the visit is on 12/18/2025 during the course of a complaint investigation # 28-AS-20251212145452 the following was observed: LPA reviewed the Admission Agreement for Resident R1 and listed under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances. Deficiency to be issued Health and Safety Code 1569.652 (c) on the 809 D page. Facility needs to update or add additional information to the refund policy. Deficiency cited on the 809D. Exit interview conducted and copy provided.the state’s words, verbatim · CDSS document, Jun 17, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(A) · Plan of correction due date: Mar 15, 2026

Admission Agreement Admission agreements shall specify the following: Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement is not met as evidenced by: Licensee has listed on the Admission Agreement for Resident R1 under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances which poses a potentail risk to residents in care.the state’s words, verbatim · CDSS document, Jun 17, 2026

Plan of correction: Licensee to update or add additional information to the refund policy on the Admission Agreement and send proof to Licensing by POC due date. Deficiency cleared on 5/13/26.

Allegation investigated: Staff did not issue a refund to a resident in care.

The purpose of this visit 5/8/2026 is to reissue citation and to include additional information. The initial visit was conducted on 12/18/2025 and included the following: Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Owner Kevork Halladjian and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegation. At today's visit the following was done: Owner Kevork Halladjian was interviewed. Staff S1 was interviewed. Administrator was interviewed telephonically. Attempts were made to interview Resident R1 were unsuccessful with being unable to respond to questioning. Interview was conducted with the Administrator telephonically. Interview was conducted with the Hospice Agency Nurse. Substantiated File was reviewed for Resident R1 and Death Report, Physician's Report and Admission Agreement to be submitted. Resident and Staff Roster submitted, File of Resident 1's Hospice agency was reviewed. In regards to the allegation Staff did not issue a refund to a resident in care, based on interviews conducted and information gathered the Owner and the Administrator both confirmed that Resident R1 did not get a refund with Admission date 12/04/25 and passing away on 12/05/25. Administrator stated that there was no refund based on having to prep the room and time it will take to get another resident. Owner stated he said no to a refund because family agreed that if it's 1 day or 30 the month is paid in full. Said that family had a contract with the Hospice Agency. Staff S1 stated that Resident R1 was only here for 1 day and was declining. Nurse from Hospice Agency stated that they are only paid by reimbursement from Medicare and that there is not a contract between resident and Hospice. Personal belongings of Resident R1 were picked up from the facility on 12/05/2026. This was confirmed by Owner Kevork Halladjian, Administrator, Staff S1 and family member of Resident R1. LPA reviewed and obtained R1's Admission Agreement. The agreement indicates "No refunds will be issued under any circumstances". Facility refund policy is not in compliance with Title 22 and Health and Safety Code and is addressed on a Case Management visit dated 5/8/2026. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. Exit interview conducted and copy provided to Owner Kevork Halladjian.the state’s words, verbatim · CDSS document, May 8, 2026 · control 28-AS-20251212145452

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: May 15, 2026

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by Resident R1's death was on 12/05 and facility would not refund for 12/6-12/31 with Personal belongings of Resident R1 were picked up from the facility on 12/05/2026. This was confirmed by Owner Kevork Halladjian, Administrator, Staff S1 and family member of Resident R1 which poses a potential risk to residents in care. which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Facility by the POC due date will issue a refund for the days pre-paid after the passing of R1 on 12/5.(12/6-12/31) and submit proof to licensing by 5/15/2026.

Type of visit: Case Management - Other

LPA Glenn Trueman made an unannounced Case Management visit to the facility and was greeted by Owner Kevork Halladjian and the purpose of the visit was explained. The reason for the visit is on 12/18/2025 during the course of a complaint investigation # 28-AS-20251212145452 the following was observed: LPA reviewed the Admission Agreement for Resident R1 and listed under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances. Deficiency to be issued Health and Safety Code 1569.652 (c) on the 809 D page. Facility needs to update or add additional information to the refund policy. Exit interview conducted and copy provided.the state’s words, verbatim · CDSS document, May 8, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: May 15, 2026

Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by: Licensee has listed on the Admission Agreement for Resident R1 under Termination of Agreement and Refund Policy it states no refunds will be issued under any circumstances which poses a potentail risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: Licensee to update or add additional information to the refund policy on the Admission Agreement and send proof to Licensing by POC due date.

Allegation investigated: Staff did not issue a refund to a resident in care.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Owner Kevork Halladjian and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegation. At today's visit the following was done: Owner Kevork Halladjian was interviewed. Staff S1 was interviewed. Administrator was interviewed telephonically. Attempts were made to interview Resident R1 were unsuccessful with being unable to respond to questioning. Interview was conducted with the Administrator telephonically. Interview was conducted with the Hospice Agency Nurse. File was reviewed for Resident R1 and Death Report, Physician's Report and Admission Agreement to be submitted. Resident and Staff Roster submitted, Substantiated File of Resident 1's Hospice agency was reviewed. In regards to the allegation Staff did not issue a refund to a resident in care, based on interviews conducted and information gathered the Owner and the Administrator both confirmed that Resident R1 did not get a refund with Admission date 12/04/25 and passing away on 12/05/25. Administrator stated that there was no refund based on having to prep the room and time it will take to get another resident. Owner stated he said no to a refund because family agreed that if it's 1 day or 30 the month is paid in full. Said that family had a contract with the Hospice Agency. Staff S1 stated that Resident R1 was only here for 1 day and was declining. Nurse from Hospice Agency stated that they are only paid by reimbursement from Medicare and that there is not a contract between resident and Hospice. Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. Exit interview conducted with Staff S1 and copies of the report given.the state’s words, verbatim · CDSS document, Dec 18, 2025 · control 28-AS-20251212145452

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Dec 26, 2025

A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement is not met as evidenced by Resident R1's death was on 12/05 and facility would not refund for 12/6-12/31 which poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, Dec 18, 2025

Plan of correction: Facility by the POC due date will issue a refund for the days pre-paid after the passing of R1 on 12/5.(12/6-12/31) and submit proof to licensing by 12/26.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an announced Pre-Licensing inspection visit. LPA met with Administrator Pauline Halladjian and Kevork Halladjian explained the reason for the visit. The facility has an approved fire clearance to be licensed to serve six (6) residents; five (5) non-ambulatory and one (1) bedridden. Bedroom #3 with direct exiting to the exterior shall house the one (1) bedridden resident. All other rooms will be non-ambulatory. LPA and Applicant toured the physical plant interior and exterior. The Pre-Licensing Inspection CARE Tool was used. The following was observed/inspected: The facility is a two-story home located in a residential neighborhood of Glendora. The home consists of 3 bedrooms, 2 bathrooms, and hal-bath for staff located near dining area, kitchen, two (2) living rooms, dining area, laundry area, backyard with a pool and an attached garage. The second floor is inaccessible to residents and will be utilized as an office and staff area. Smoke and carbon monoxide combination detectors observed, tested and are operable. The fire extinguisher located in the dining are was observed and charged. Appliances such as a microwave, refrigerator and stove were observed to be clean and operating properly. Sharps were observed secured under the kitchen sink, inaccessible to residents. continued on LIC 809C continued from LIC809, page 2 Centrally stored medication will be located in a locked cabinet located in the kitchen. Staff and client files will be maintained locked in a cabinet located in a hallway closet. Dining area was observed clean with sufficient seating for six (6) residents. Fireplace in dining area is not operational. Living rooms were observed free of obstructions with sufficient seating and space to promote and facilitate the program of activities. Fireplace in the living room had a covered screen. All cleaning solutions and disinfectants were observed locked under the kitchen sink, laundry area and garage. Grab bars and non-skid mats were observed in the hallway bathroom. The shower in the private bathroom located in a resident bedroom will not be utilized. The water temperature was tested in both bathrooms and measured at 116 and 112.6 degrees F, within the required 105-120 degrees F. Residents’ bedrooms have all required furniture which include, for each resident, a bed equipped with good springs, a clean and comfortable mattress, available pillow(s) and lightweight warm bedding, fillings and covers for mattresses and pillows were flame retardant, a chair, nightstand, a lamp, or lights sufficient for reading, and a chest of drawers. Bed linens were clean and in good repair. There was closet space for clothing and other belongings. Extra clean linens were observed in the hallway storage cabinet. No bedroom of a resident shall be used as a passageway to bathroom or outdoors. Doors, exits, hallways, and passageways were clear and free of obstruction. The front and back yards were observed to be clean and free of debris. LPA observed the backyard to have a covered seating area with sufficient seating for six (6) residents and a pool which was made inaccessible through fencing. LPA observed a locked pool gate that opens away from pool and self-latches. LPA observed the surrounding area did not have any objects that can be used to climb over the fence. continued on LIC 809 page 3 Backyard contained a pool house for private use, locked and inaccessible to residents. Per facility sketch (additional area 2) contains separate, private living quarters, possibly for staff. LPA provided applicant with the following information: • PIN 24-03-ASC, Subject: Safety Requirements for Facilities with Pools and Other Bodies of Water • LIC 311F, Records to be Maintained at the Facility- Residential Care Facility for the Elderly Comp III was completed during today’s visit with applicant Pauline Halladjian. The Pre-licensing is complete, and the facility has no deficiencies. An exit interview was conducted, and a copy of this report has been provided to applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Sep 4, 2025