Ebell Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:29 AM. LPA met with facility staff who contacted facility Administrator Lusine Tadevosyan via telephone call. The facility Administrator arrived to the facility at approximately 11:15 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:32 AM, the LPA, along with facility staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: COMMON AREAS: This included the living room, dining room, and hallways. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contained a couch, a television, activities for resident use, and an appropriately secured fireplace. LPA observed all required postings for the facility located on the entryway wall. The dining room was observed to be clean and contained adequate seating for resident use. LPA observed the dining room to contain a fire extinguisher that was fully charged and was purchased on 06/11/2026. The hallway was observed to be clear from obstructions. The hallway contained storage for linens and care supplies in addition to a closet which contained emergency water supplies, care supplies, and personal grooming supplies. BEDROOMS: There are three (3) bedrooms in the facility. LPA and facility staff toured all three (3) bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. LPA observed one (1) resident bed to contain full bed rails. Bedrooms #2&3 contained direct exits to the outdoors of the facility. CONTINUED ON LIC 809C. INTERVIEWS: LPA interviewed one (1) resident. The resident interviewed stated that the staff treat them well and are attentive to their needs. LPA interviewed one (1) staff member. The staff member interviewed was knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, emergency disaster plan, and current liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited and civil penalty was assessed (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided. RECORD REVIEW: Record review began at 11:27 AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Four (4) staff files were reviewed. All staff files contained all required documentation and signatures. Two (2) resident files were reviewed. LPA observed Resident #1 (R1)'s physician report which indicated that R1 had an ambulatory status of "Bedridden". LPA observed the facility's fire clearance to allow one (1) bedridden resident in room #3 of the facility. LPA observed that R1 resided in room #2 of the facility. LPA notified the Administrator that R1 being bedridden and residing in the wrong room constitutes a violation of the facility’s fire clearance. LPA informed the Administrator that this is a zero-tolerance violation and an immediate civil penalty in the amount of $500 will be assessed on today’s date (06/29/2026). MEDICATION REVIEW: Medication review began at 01:41 PM. Medications for two (2) of two (2) residents were observed. All medications were stored properly. Two (2) medications were observed to have inaccurate pill counts and one (1) medication was observed to have half of a pill left imbedded in the bubble pack. LPA asked the Administrator why the pill count was off and why half of the pill was left inside the packaging. The Administrator stated that they had written the incorrect expiration date for the medication and ceased administration without a doctor’s order and that the pill must have broken in half when popped from the pack. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as they pertain to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 06/11/2026. The facility’s emergency disaster plan contained inaccurate information pertaining to the emergency supplies the facility had on hand. LPA informed the Administrator that they had recently signed off that the plan was reviewed but due to the inaccurate emergency supplies the plan could need to be updated. The Administrator retrieved a previous emergency disaster plan, signed the previous plan as being reviewed on 06/29/2026, and tore the more recent plan in half before LPA could make a copy of the plan. Both the infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. CONTINUED ON LIC 809C. BATHROOMS: There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared resident bathrooms and one (1) is designated as a staff bathroom. All bathrooms were observed to be clean and in good repair and all were equipped with nonskid surfaces. Grab bars were observed in all showers, one (1) resident toilet was observed to be missing grab bars. All grab bars observed were properly secured. The water temperature was measured to be between 111.9 and 115.5 degrees Fahrenheit, which is within the range required by regulation. LPA observed an unsecured bottle which was unlabeled and contained a clear liquid on the floor of a resident bathroom. LPA observed this bottle to contain bleach. LPA notified facility staff who immediately secured the item. LPA observed a bathroom that was attached to bedroom #2. Facility staff informed LPA that this bathroom was being utilized as a staff bathroom only. LPA observed this bathroom’s door to contain a sign which indicated that the bathroom was a staff bathroom only. LPA notified facility staff and Administrator that no bedroom of a resident shall be used as a passageway to another room, bath or toilet. KITCHEN/LAUNDRY: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility had a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured lock box which contained knives and other sharp objects. LPA observed an unsecured bottle of spray cleaner located in a cabinet under the kitchen sink. LPA notified staff who immediately secured the item. LPA observed the laundry to be located adjacent to the kitchen. LPA observed a secured cabinet in the laundry which contained detergents and extra cleaning supplies. OUTDOOR SPACE: The facility had one (1) emergency exit gate located in the front yard. All railings located at the facility were secured properly. LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed the backyard to contain two (2) storage sheds which contained gardening supplies and additional care supplies. LPA observed an unsecured pair of gardening shears and an unsecured bottle of pesticides. LPA notified facility staff who immediately secured the items. CONTINUED ON LIC 809C.the state’s words, verbatim · CDSS document, Jun 29, 2026

The state marks this report as 13 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Trevor Byrne conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Susanna Mambreyan. This is a new facility. A dementia care program was included in the plan of operation. A Hospice Waiver has been requested. The facility is a one-story home. At 10:24 AM, a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for five (5) non-ambulatory residents and, one (1) bedridden resident. The facility has three (3) shared resident rooms. Rooms # 2 and 3 have direct exits to the outside. Bedroom #3 is the bedridden approved room. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen, which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet There are no staff rooms, awake night staff is required. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the hallway and one (1) private bathroom attached to bedroom #2. The resident bathrooms have a shower with non-skid materials. The toilets and showers have grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. Continued on LIC 809C. Resident and staff records, along with resident medications, are stored in a cabinet which is currently located in the dining area. The first aid supplies were complete, including a thermometer and a current version of a first aid manual. Kitchen knives are stored in a locked box in the kitchen. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the laundry room. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment, games and/or activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. LPA observed the front entrance stairs to be missing appropriate hand railings. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is a fireplace in the living room, it is screened and there are no tools. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There is one (1) of fire extinguisher throughout the house. It was fully charged and does not exceed the expiration date. Continued on LIC 809C. Hot water was tested in each bathroom, which included the resident bathrooms and any common bathrooms, in addition to the kitchen; and the hot water ranged from 110.7 to 117.1 degrees Fahrenheit. The laundry area is located adjacent to the kitchen. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in the hallway closet. Extra incontinence supplies are stored in the outdoor storage shed. There is a functioning telephone on the premises. The emergency exiting plans, emergency telephone, and other required postings are posted at the front entrance to the facility. The exterior passageways were clean and clear of any obstructions. There is a shaded patio area at the back of the house with tables and chairs where residents can sit. The entire property is fenced. The back and sides of the house are separated from the front yard by gates at the East and West side passageways. The gate to the driveway is moved automatically. There is a door w/gate for persons to enter the front yard. There are six (6) storage shed in the back yard. The backyard contains an additional structure associated with the property. There are not any bodies of water on the premises at the present time. COMP III orientation was completed with the applicant during this pre-licensing inspection. The following item must be corrected prior to licensure. Submit proof of corrections, along with a copy of this report, to LPA Byrne so that your application may be completed. This report will be sent to the Centralized Application Bureau (CAB) once all corrections are received. You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. 87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted.the state’s words, verbatim · CDSS document, Jun 18, 2025