Eldercare Homes

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a case management - other visit at 03:15 PM. LPA met with facility staff who contacted the Assistant Administrator Tina Arutyunyan. The Assistant Administrator was unable to come to the facility at the time of the visit but has designated facility staff to sign this report on their behalf. Entrance interview conducted and the reason for the visit was explained. On 02/25/2026 Community Care Licensing Division (CCLD) received an appeal for a type-A deficiency that was issued for a violation of Health and Safety Code (HSC) 1569.605. Additionally, the facility received a failure to correct civil penalty on 03/05/2026. The appeal for the deficiency was granted on 05/08/2026 and the deficiency was subsequently downgraded to a type-B deficiency. Additionally, the civil penalty for this deficiency has been dismissed. This report is being generated with a type-B deficiency of HSC 1569.605 and the original type-A deficiency attached to the 02/23/2026 annual visit is dismissed. The following deficiency was cited (Refer to LIC 809D). This report was read to the Assistant Administrator via telephone call. Exit interview was conducted, a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 24, 2026

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Jun 24, 2026

§1569.605 Liability insurance; coverage requirements On and after July 1, 2015, all residential care facilities for the elderly...shall maintain liability insurance... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as the facility was unable to provide proof of active liability insurance which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 24, 2026

Plan of correction: Liability insurance was received on 03/05/2026. POC cleared.

Type of visit: POC

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a case management – plan of correction (POC) visit at 09:46 AM. LPA met with facility staff who contacted the Assistant Administrator Tina Arutyunyan. Entrance interview conducted with the Assistant Administrator over the phone and the reason for the visit was explained. LPA attempted to contact the facility Administrator Luiza Hekimyan via telephone call but did not receive a response. On 02/23/2026 during the required annual visit the facility was cited for a violation of Health and Safety Code (HSC) 1569.605 which states “On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.” During the annual visit the facility was unable to provide proof of active liability insurance which posed an immediate health, safety or personal rights risk to persons in care. The facility was given a POC due date of 02/24/2026 where the Administrator agreed to provide Community Care Licensing Division (CCLD) with proof of active liability insurance no later than POC due date. CONTINUED ON LIC 809C. During today’s visit LPA informed the Assistant Administrator that CCLD still had not received proof of active liability insurance. LPA requested the Assistant Administrator to provide proof of active liability insurance during the visit. On 03/04/2026 at 11:46 AM LPA sent an email to Administrator informing them that the Plan of Correction (POC) was outstanding and that failure to correct the deficiency may result in the assessment of civil penalties for a failure to correct. The Department assesses a Failure to Correct Civil Penalty when a licensee fails to correct a deficiency by the POC due date. All facilities, except Resource Families and governmental entities that hold a community care facility license, including a state, county, or city, are subject to Failure to Correct Civil Penalties. The Department assesses a civil penalty of $100 for each calendar day, or portion of a day, that a deficiency remains uncorrected after the POC due date. The Assistant Administrator provided LPA with a copy of the facility's liability insurance with a policy effective date of 03/06/2026-03/06/2027 and a policy number of "TBD". LPA asked why the liablilty insurance was effective one (1) day after today's (03/05/2026) visit and why there was no policy number. Assistant Administrator stated that they were "Waiting for the insurance company to give a number. End of today or tomorrow we'll have it". LPA explained that this document does not provide proof of coverage as it is not effective as of today's (03/05/2026) date and has no policy number. LPA informed the Assistant Administrator that because the facility did not correct the deficiency within the given timeframe a civil penalty in the amount of $900 is being assessed on today’s date for the failure to correct HSC 1569.605 by 02/24/2026. The penalty amount of $900 is calculated as $100/day past the due date of the POC (9 days x $100/day = $900). LPA informed the Assistant Administrator that penalties in the amount of $100/day will continue to be assessed until proof of liability insurance is received. Pursuant to HSC, the following civil penalty was assessed (refer to LIC 421FC): Exit interview conducted with the Assistant Administrator via telephone call and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 5, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct the required annual visit at 10:01 AM. LPA met with facility staff who contacted the Administrator Luiza Hekimyan. The Administrator and the facility backup Administrator Tina Arutyunyan arrived to the facility at approximately 11:05 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at approximately 10:30 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 dining area, living room, hallway, and office. LPA observed the dining area to be clean and properly furnished at the time of the visit. The dining area contained a dining table with adequate seating for resident use and the facility’s adequate emergency water supply. The living room was observed to be clean and contained adequate seating for resident use. Additionally, the living room contained an adequately screened fireplace and activities for resident use. LPA observed the hallway to contain closets which contained non-perishable foods, care supplies, and extra linens. The office was observed to contain facility, resident, and staff files. The facility’s fire and carbon monoxide alarms were tested between 11:22 AM and 11:24 AM and functioned properly at the time of the test. All exits in the facility were observed to contain auditory alarms. BATHROOMS: There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared resident bathrooms and one (1) bathroom is designated as a staff bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured to be between 111.7 and 105.8 degrees Fahrenheit, which is within the range required by regulation. LPA observed all bathrooms to contain unsecured personal grooming supplies. CONT. KITCHEN: 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 drawer which contained knives and other sharp objects, a secured cabinet which contained resident medications, and a properly secured under-sink cabinet which contained cleaning supplies. LPA observed the laundry closet located adjacent to the kitchen. The laundry closet contained a washer and dryer and properly secured cabinets which contained laundry chemicals. LPA observed a fire extinguisher mounted in the kitchen to be fully charged and purchased on 09/24/2025. BEDROOMS: There are seven (7) bedrooms in the facility; six (6) are single occupancy resident rooms and one (1) is a staff room. LPA toured all six (6) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All bedrooms contained direct exits to the outdoors of the facility. Bedroom #1 and 2 contained unsecured grooming supplies. OUTDOOR SPACE: The facility has three (3) emergency exit gates. Two (2) are located in the front yard and one (1) is located in the backyard; LPA observed clear passageways for emergency exit use. The facility had adequate shaded seating outdoors for resident use. LPA observed all rails to be appropriately secured at the time of the visit. LPA observed cameras throughout the outdoor areas of the facility. LPA observed the garage to be locked and inaccessible to clients in care. The garage was observed to contain cleaning supplies, extra care supplies, household tools, and chemicals. RECORD REVIEW: Record review began at 11:30 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. One (1) staff file was observed to be missing from the facility. LPA informed the Administrator that all personnel records shall be maintained at the facility and shall be available to the licensing agency for review. The Administrator expressed understanding and printed the missing employee file at the time of the visit. Six (6) resident files were reviewed. Three (3) residents were identified by their physician as having their safety at risk if allowed access to personal care and hygiene items. LPA informed the Administrator that due to the condition or the habits of the residents in the facility the licensee is required to centrally store the grooming supplies so as not to pose a safety hazard to the clients identified. The Administrator agreed to place all grooming and personal hygiene items throughout the facility into secured storage. CONT. MEDICATION REVIEW: Medication review began at 01:38 PM. Medications for three (3) of six (6) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. LPA observed two (2) residents to have PRN medications without completed PRN authorization forms. LPA informed the Administrator that each resident needs a completed PRN authorization form that shows if the resident is able to determine and communicate their need for a prescription or nonprescription PRN medication. The Administrator expressed understanding and agreed to complete PRN authorization forms for all identified individuals. 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 01/03/2026. The infection control plan and the emergency disaster plan are reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. LPA interviewed two (2) staff members. Both staff members interviewed were knowledgeable on 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 disaster plan, LIC 500, and resident roster. LPA was unable to obtain proof of liability insurance during today's visit. LPA informed the Administrator that all residential care facilities for the elderly shall maintain liability insurance in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate. The Administrator expressed understanding and agreed to provide a copy of the active liability insurance once obtained. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 23, 2026

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Resident was admitted to hospice without consent.

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint visit for the above allegation. LPA arrived to the facility at 01:28 PM. LPA met with facility staff who contacted the facility Assistant Administrator, Tina Arutyunyan, via telephone call. The Assistant Administrator was unable to come to the facility during today's visit. Entrance interview was conducted and the reason for the visit was explained. On 03/11/2025, the LPA initiated the investigation and conducted a physical plant tour, collected copies of pertinent documents, and conducted interviews with the Administrator, the Assistant Administrator, and one (1) staff member between 10:35 AM. and 12:30 PM. On 04/11/2025, the LPA conducted a subsequent visit and conducted a physical plant tour, conducted a medication review for four (4) residents, and conducted interviews with the Administrator, the Assistant Administrator, five (5) residents, and three (3) witnesses between 09:30 AM. and 01:15 PM. Continued on LIC 9099C. Substantiated During today’s visit, the LPA conducted a brief physical plant tour and delivered findings for the above allegation between 01:28 PM. and 02:50 PM. The allegation of “Resident was admitted to hospice without consent” alleges that Resident #1 (R1) was transferred to a Hospice company without their or their Durable Power of Attorney (DPOA)’s consent. LPA reviewed R1’s file and observed hospice admission paperwork for the Hospice company in question. LPA observed R1’s name and a signature on the admission documents. LPA interviewed R1 and provided them the document for review. R1 confirmed that the signature and the initials on the document did not match their own. LPA interviewed DPOA who confirmed that they did not give consent for R1 to be enrolled in the Hospice company. LPA interviewed staff #1 (S1), the facility Administrator, and the Assistant Administrator. All staff interviewed denied requesting the transfer of R1 onto the Hospice company but were unsure why R1 was enrolled with the company. Based on interviews with witness #1 (W1) LPA confirmed that due to R1’s condition, R1 was mentally unable to consent to signing up for hospice care at the time they were enrolled with the Hospice company. LPA confirmed that at the time R1 was enrolled with the Hospice company, R1 was under the care and supervision of the facility. LPA reviewed documentation from the Department of Health & Human Services which stated that as of 04/07/2025 the Hospice company has had their Medicare provider agreement involuntarily terminated and is no longer operating. Based on the information obtained during interviews and file review there is sufficient evidence to support the allegation of “Resident was admitted to hospice without consent.” Therefore, the allegation is deemed Substantiated at this time. The Assistant Administrator was unable to come to the facility during today's visit but has designated S1 to sign this report on their behalf. This report was read to the Assistant Administrator via telephone call. The following deficiency was cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted. During today’s visit, the LPA conducted a brief physical plant tour and delivered findings for the above allegations between 01:28 PM. and 02:50 PM. The allegation of “Staff make residents stay in bed all day” alleges that facility staff do not assist residents with leaving their beds and require that they remain in bed throughout the day. LPA interviewed five (5) residents of the facility. Residents interviewed had no concerns about staff not assisting them in transferring from their bed. Additionally, no residents interviewed stated that they are required by staff to remain in bed during the day. Resident #1 (R1) stated that they have a walker in their room and ask staff for assistance with utilizing the device but have been asked to build leg strength before attempting to use the walker. Interviews with R1’s Durable Power of Attorney (DPOA), Staff #1 (S1), and R1 revealed that during early 2025 R1 was not physically well enough to move about the facility with significant staff assistance. S1 stated that they attempted to move R1 from their bed to the dining table for meals but R1 was unwilling and unable to move so meal service to R1’s bed was provided until R1 recovered. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff make residents stay in bed all day.” Therefore, the allegation is deemed Unsubstantiated at this time. The allegation of “Staff falsified resident records” alleges that R1’s records contained falsified signatures. LPA reviewed R1’s file and observed R1’s physician report to be signed by an emergency room doctor. LPA contacted the phone number listed, and the representative was able to confirm that the doctor did work in their emergency room. All other required documentation located in R1’s file appeared to be signed by DPOA and a facility representative. LPA observed R1’s hospice admission paperwork for Hospice. LPA observed a signature on the admission document but interviews with R1 and DPOA revealed that this signature did not match R1’s signature. LPA interviewed S1, the Administrator, and the assistant Administrator, all of whom denied falsifying the signature. Although the signature on R1’s hospice paperwork was confirmed to be falsified there is insufficient evidence to prove facility culpability as it remains unclear who falsified the signature. LPA reviewed documentation from the Department of Health & Human Services which stated that as of 04/07/2025 the Hospice company has had their Medicare provider agreement involuntarily terminated and is no longer operating. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Staff falsified resident records.” Therefore, the allegation is deemed Unsubstantiated at this time. Continued on LIC 9099C. The Assistant Administrator was unable to come to the facility during today's visit but has designated S1 to sign this report on their behalf. This report was read to the Assistant Administrator via telephone call. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 29-AS-20250319084954

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(7) · Plan of correction due date: Nov 6, 2025

87468.2 Additional Personal Rights... (a) ...shall have all of the following personal rights: (7) To fully participate in planning their care, ... and involve persons of their choice in this planning... This requirement is not met as evidenced by: Based on interviews and record review the licensee did not comply with the section cited above as R1 was fraduantly enrolled with a hospice company with a falsified signature while under the care and supervision of the facility which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Assistant Administrator agreed to submit a signed statement of understanding confirming that they understand the importance of residents participating in the planning of their care and confirming that they will review future documents for signs of falsified information/foargaries of signatures... ... Assistant Administrator agreed to submit the statement to CCLD no later than POC due date.

Allegation investigated: Physical Abuse

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced subsequent complaint visit for the above allegation. LPA arrived to the facility at 01:28 PM. LPA met with facility staff who contacted the facility Assistant Administrator, Tina Arutyunyan, via telephone call. The Assistant Administrator was unable to come to the facility during today's visit. Entrance interview was conducted and the reason for the visit was explained. On 05/09/2025, LPA Byrne conducted an unannounced complaint visit. During the inspection, the LPA conducted a file review for one (1) resident, collected copies of pertinent documentation, and conducted interviews with the Administrator, the Assistant Administrator, two (2) staff members, and three (3) residents between 10:00 AM. and 12:30 PM. During today’s visit, the LPA conducted a brief physical plant tour and delivered findings for the above allegation between 01:28 PM. and 02:50 PM. Continued on LIC 9099C. Unsubstantiated The allegation of “Physical Abuse” alleges that staff #1 (S1) pushed resident #1 (R1) causing R1 to fall and hit their head. LPA interviewed the Administrator, the Assistant Administrator, S1, and R1. Parties interviewed stated that the incident between S1 and R1 occurred in the evening hours of 05/07/2025 at approximately 10:00 PM. R1 reported that during the evening of 05/07/2025 they felt as though the temperature in their room was too hot. R1 stated that S1 came into their room and R1 asked for the temperature to be turned down. R1 stated that they and S1 got into an argument because R1 did not want S1 in their room. R1 stated that S1 reached up with both hands and shoved R1 on the shoulders which caused R1 to fall backwards hitting the back of their chair and hitting their head on the wall. R1 reported suffering a “Bump” on the back of their head and two (2) bruises, one (1) on each of their arms. The interview with S1 revealed S1 recalled the incident and reported hearing noises coming from R1’s room in the evening of 05/07/2025. S1 stated that they approached R1’s room and opened the door. S1 stated that R1 approached them aggressively and grabbed S1 by the shoulders and screamed "It’s so hot turn the AC on!" S1 stated that they replied that they would but R1 continued screaming and would not let go of S1’s shoulders. S1 stated that they broke free of R1’s grip by pushing R1’s elbows. S1 denied R1 falling from this contact. S1 stated that once they were free from R1’s grip they closed the door to R1’s room to prevent R1 from approaching them again. S1 reported holding the door closed and hearing a thump from the other side of the door after a moment. S1 reported opening the door and observing R1 sitting on the floor with their back against the back of their chair. S1 contacted emergency services and the facility Administrator. Continued on LIC 9099C. Interviews with the Administrator, the Assistant Administrator, S1, and R1 all revealed that paramedics arrived to the facility. Paramedics assisted R1 up from the floor and conducted an assessment of R1. R1 was not transported to the hospital due to lack of apparent injury and R1’s refusal to go to the hospital. Paramedics advised the facility to contact law enforcement. Law enforcement was contacted and arrived at the facility at approximately midnight. Law enforcement took a report but did not transport R1 or S1 and no charges were filed. LPA observed R1 and R1’s room. LPA observed the back of R1’s head to contain minor redness that appeared to be scalp irritation but did not observe a bump, lump, or bruise. LPA observed two (2) small bruises of indeterminate age on R1’s forearms. LPA observed R1’s room and did not observe any damage to the drywall where R1 reported hitting their head. LPA interviewed two (2) other residents of the facility. Both residents denied overhearing the altercation on 05/07/2025 and both residents denied facility staff ever being aggressive or yelling at the residents of the facility. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Physical Abuse.” Therefore, the allegation is deemed Unsubstantiated at this time. The Assistant Administrator was unable to come to the facility during today's visit but has designated S1 to sign this report on their behalf. This report was read to the Assistant Administrator via telephone call. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 29-AS-20250508130427

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced case management – deficiencies visit at the facility. LPA arrived to the facility at 01:28 PM. LPA met with facility staff who contacted the facility Assistant Administrator, Tina Arutyunyan, via telephone call. The Assistant Administrator was unable to come to the facility during today's visit. Entrance interview was conducted and the reason for the visit was explained. During a complaint investigation visit to the facility on 05/09/2025 LPA interviewed the facility Administrator, the assistant Administrator, and Staff #1 (S1) about an altercation that occurred between S1 and Resident #1 (R1) on 05/07/2025. During the interviews with the Administrator, the assistant Administrator, and S1 it was revealed that during the altercation S1 held the door to R1’s room closed and prevented R1 from leaving their room which resulted in R1 suffering a fall. LPA informed the the assistant Administrator, and S1 that personal rights of residents forbid staff from involuntarily secluding or locking residents in any room of the facility. LPA had a conversation with the goal of educating facility staff on the personal rights of residents and the appropriate responses to behavioral expressions of residents. The assistant Administrator, and S1 expressed understanding of the personal rights of residents and the appropriate responses to resident’s behavioral expressions. The Assistant Administrator was unable to come to the facility during today's visit but has designated S1 to sign this report on their behalf. This report was read to the Assistant Administrator via telephone call. The following deficiency was cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.the state’s words, verbatim · CDSS document, Oct 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Oct 24, 2025

87468.1 Personal Rights of Residents... (a) ...shall have... personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night... This requirement is not met as evidenced by: Based on interviews the licensee did not comply with the section cited above as during an altercation S1 held the door to R1’s room closed and prevented R1 from leaving their room which resulted in R1 suffering a fall which posed an immediate safety and personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Oct 23, 2025

Plan of correction: Assistant Administrator agreed to submit their plan on how they will appropriately respond to behavioral expressions of residents. Additionally, Administrator agreed to conduct a training with all staff members on the appropriate response to behavioral expressions and will submit proof of... ...Completed trainings to CCLD no later than POC due date.

Allegation investigated: Staff did not meet a resident's dietary needs

Licensing Program Analyst (LPA) Trevor Byrne conducted an unannounced complaint visit for the above allegation. LPA arrived to the facility at 09:54 AM. LPA met with facility staff who contacted the facility Administrator, Luiza Hekimyan, and the facility Assistant Administrator, Tina Arutyunyan, via telephone call. The Administrator and the Assistant Administrator arrived shortly after. Entrance interviews were conducted and the reason for the visit was explained. During today’s visit, the LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted a file review for one (1) resident, collected copies of pertinent documentation, and conducted interviews with the Administrator, the Assistant Administrator, two (2) staff members, and three (3) residents between 10:00 AM. and 12:30 PM. Continued on LIC-9099C Substantiated The allegation of “Staff did not meet a resident's dietary needs” alleges that the facility did not adhere to the dietary restrictions of resident #1 (R1). LPA Byrne interviewed R1 who stated that they are lactose intolerant and facility staff are aware of this dietary restriction. R1 stated that they were given cereal with milk by staff #1 (S1) on the morning of 05/08/2025. R1 stated that as a result of consuming the cereal and milk the suffered an episode of diarrhea for a few hours. LPA interviewed S1 who admitted to giving R1 cereal with milk in the morning of 05/08/2025. S1 stated that they were aware that R1 cannot have milk due to their lactose intolerance. S1 stated that R1 had a total of three (3) bowel movements between 09:15 AM and 10:15 AM after being given cereal and milk. S1 stated that they informed the responsible party of R1 immediately and offered their apologies for the incident. LPA interviewed staff #2 (S2) who confirmed that R1 had 3 bowel movements on the morning of 05/08/2025. S2 stated that they assisted in changing R1 and described the bowel movements as normal. LPA interviewed the Administrator who stated that they were unaware of R1’s lactose intolerance or R1 being given milk with cereal. LPA requested that the Administrator submit an incident report to Community Care Licensing for this incident, the Administrator agreed to submit an incident report. LPA interviewed two (2) additional residents. One (1) resident interviewed, resident #2 (R2) had a dietary restriction. R2 stated that the facility adheres to their dietary needs. R2 had no concerns about the facility’s food service. Based on the information obtained during interviews there is sufficient evidence to support the allegation of “Staff did not meet a resident's dietary needs.” Therefore, the allegation is deemed Substantiated at this time. The following deficiency was cited (refer to LIC 9099D). A copy of the report was printed, appeal rights were provided, and exit interview was conducted.the state’s words, verbatim · CDSS document, May 9, 2025 · control 29-AS-20250508130427

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(5) · Plan of correction due date: May 23, 2025

87468.2 Additional Personal Rights of Residents... (a) In addition...residents...shall have all of the following personal rights: (5) To be served food... necessary to meet their nutritional needs. This requirement is not met as evidenced by: Based on interviews the licensee did not comply with the section cited above as one resident was served milk while being lactose intolerant which caused them to have 3 bowel movements in a 1 hour timeframe which poses a potential health risk to clients in care.the state’s words, verbatim · CDSS document, May 9, 2025

Plan of correction: Administrator agreed to conduct training with facility staff on the importance of adhering to the dietary needs of facility residents. Licensee will submit proof of training attendance to CCLD no later than POC due date.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Resident was prescribed medication without notifying the authorized representative

Licensing Program Analyst (LPA) Trevor Byrne conducted a follow-up complaint visit for the above allegation. LPA arrived to the facility at 09:29 AM. LPA met with facility staff who contacted the facility Administrator, Luiza Hekimyan, and the facility Assistant Administrator, Tina Arutyunyan, via telephone call. The Administrator and the Assistant Administrator arrived at approximately 10:00 AM. Entrance interviews were conducted and the reason for the visit was explained. During the initial complaint visit on 03/21/2025 the LPA conducted a physical plant tour, collected copies of pertinent documents, and conducted interviews with the Administrator, the Assistant Administrator, and one (1) staff member between 10:35 AM. and 12:30 PM. During today’s visit, the LPA conducted a physical plant tour to ensure there are no health and safety hazards, conducted a medication review for four (4) residents, and conducted interviews with the Administrator, the Assistant Administrator, five (5) residents, and three (3) witnesses between 09:30 AM. and 01:15 PM. Unsubstantiated The allegation of “Resident was prescribed medication without notifying the authorized representative” alleges that facility staff #1 (S1) requested the resident’s Hospice agency to prescribe R1 with psychotherapeutic drugs without notifying Durable Power of Attorney (DPOA) of the medication request. LPA reviewed R1’s hospice paperwork and the resident’s centrally stored medication and destruction record sheet (CSMDR). The paperwork indicated that all medications that the hospice company ordered were prescribed by a physician. LPA confirmed that the medications on the hospice paperwork matched those listed on R1’s CSMDR. LPA interviewed S1, the Assistant Administrator and the Administrator all of whom confirmed that the facility followed the administration instructions of the resident’s prescribed medications. All staff denied requesting the hospice company to prescribe R1 with psychotherapeutic medications. Additionally, LPA received a copy of a text conversation between DPOA and the Assistant Administrator. In this conversation DPOA informed staff of medications that R1 used to take to assist in managing their agitation. DPOA suggested to staff to speak with R1’s nurse and get the medication prescribed. Although the allegation may have happened or is valid there is insufficient evidence to support the allegation of, “Resident was prescribed medication without notifying the authorized representative.” Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. Report was reviewed and a copy was provided.the state’s words, verbatim · CDSS document, Apr 11, 2025 · control 29-AS-20250319084954

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:50 AM. LPA met with facility staff who contacted the facility backup Administrator Tina Arutyunyan. The backup Administrator arrived to the facility at 11:40 AM. Entrance interview conducted and the reason for the visit was explained. Beginning at 10:52 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: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. LPA observed a secured cabinet to contain resident medications. LPA observed a properly secured under-sink cabinet to contain cleaning supplies. LPA observed the laundry closet located adjacent to the kitchen. The laundry closet contained a washer and dryer and properly secured cabinets containing laundry chemicals. LPA observed a fire extinguisher mounted in the kitchen to be fully charged and purchased on 09/24/2024. Continued on LIC 809C. COMMON AREAS: This includes the dining area, living room, hallway, office. LPA observed the dining area to be clean and properly furnished at the time of the visit. The dining area contains a dining table with adequate seating for resident use. The living room was observed to be clean with adequate seating for resident use. LPA observed the living room to contain an adequately screened fireplace and activities for resident use. LPA observed one (1) hallway closet to contain non-perishable foods and emergency water supplies. One (1) additional hallway closet was observed to contain extra care supplies. LPA observed one (1) railing support in the hallway to be detached from the railing. The office was observed to be locked and inaccessible to clients in care. At 11:23 AM LPA observed the sliding door screen to contain a tear in the screen material. The facility’s fire and carbon monoxide alarms were tested at 11:33 AM. The facility’s fire alarm functioned properly at the time of the visit. At 11:33 AM LPA observed the facility’s carbon monoxide alarm to fail to function during the test. The facility backup Administrator replaced the carbon monoxide alarm at the time of the visit. All exits in the facility were observed to contain functioning auditory alarms. BEDROOMS: There are seven (7) bedrooms in the facility; six (6) are single occupancy resident rooms and one (1) is a staff room. LPA and facility staff toured all six (6) resident bedrooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. At 11:26 AM LPA observed bedroom #1’s sliding screen door to contain a tear in the screen material. BATHROOMS: There are three (3) bathrooms at the facility. Two (2) bathrooms are designated as shared resident bathrooms and one (1) bathroom is designated as a staff bathroom. Both resident bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in all resident showers and near all resident toilets, all were properly secured. The water temperature was measured between 141.4 and 163.6 degrees Fahrenheit, which is outside of the range required by regulation. OUTDOOR SPACE: The facility has three (3) emergency exit gates. Two (2) are located in the front yard and one (1) is located in the backyard; LPA observed clear passageways for emergency exit use. The facility has adequate seating outdoors for resident use. At 11:24 PM LPA observed the facility’s backyard to be missing adequate shade for the seating area. LPA observed all rails to be appropriately secured at the time of the visit. Continued on LIC 809C. GARAGE: LPA observed the garage to be locked and inaccessible to clients in care. The garage was observed to contain cleaning supplies and extra care supplies, household tools, and chemicals. RECORD REVIEW: Record review began at 11:40 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. Six (6) staff files were reviewed. One (1) staff file was observed to be missing the required LIC 501 Personnel Record sheet and LIC 508 Out-of-state disclosure sheet. One (1) staff file was observed to be missing the LIC 503 Health screening report – facility personnel and a negative TB test. One (1) file for a staff member, who was working at the time of the inspection, was not located at the facility. LPA observed all caregiver staff members to be missing adequate trainings conducted within the last 12 months. Four (4) resident files were reviewed. One (1) resident’s physician report was observed to not be updated following a change in condition. Additionally, the resident's file was observed to be missing a negative TB test. MEDICATION REVIEW: Medication review began at 01:50 PM. Medications for four (4) of four (4) residents were observed. All medications were stored properly and were appropriately documented on their respective centrally stored medication and destruction record sheets. No deficiencies were observed during medication review. 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 it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly; the facility’s last emergency disaster drill was conducted on 01/10/2025. LPA observed the facility to be utilizing an out-of-date LIC 610E, Emergency Disaster Plan for Residential Care Facilities for The Elderly. The infection control plan is reviewed/updated annually by the facility’s Administrator. INTERVIEWS: LPA interviewed two (2) residents. The residents interviewed stated that the staff treat them well and are attentive to their needs. LPA interviewed two (2) staff members. Both staff members interviewed were knowledgeable on the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse. Continued on LIC 809C. During today’s visit LPA obtained a copy of the facility’s LIC 500, resident roster, and liability insurance. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report was issued and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 18, 2025

The state marks this report as 10 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. LPA Urena arrived at 9:50 a.m. Staff greeted the LPA and contacted the facility representative Tina Arutyunyan via telephone. The facility representative arrived shortly thereafter. LPA Urena, and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen knives are stored locked and inaccessible in a kitchen drawer. A seven-day supply of non- perishable foods was available. The supply of dishes is adequate. Appliances in the kitchen were clean and all appeared functional. Kitchen, laundry, and house cleaning supplies are stored, locked, and located in the laundry room which is adjacent to the kitchen. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 70 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. One fire extinguisher located by the kitchen area was purchased on 09/12/2023. The LPA observed required postings throughout the common space. BEDROOMS: Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are three designated client rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. BATHROOMS: Bathrooms were clean, shower area was in clean condition with grab bars and a non-skid mat available. Paper towels were available for drying hands. Hand washing signs were displayed, and sufficient amounts of soap and paper products in each restroom. Continues on LIC 809C... OUTDOOR SPACE/GARAGE: Backyard is equipped with furniture in good repair for residents’ use. There were no bodies of water noted. Side gate is unlocked, and passageways were clear of any obstructions. The garage is detached from the main house, and the door was locked at the time of the visit. RECORDS: Records review began at 11:57 a.m.., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 1:00 p.m. ; medications are centrally stored and locked in a cabinet in the kitchen area; medications are labeled and checked for expiration dates. During the medication review, it was observed that the medications were not properly documented on the centrally stored medications and destruction record (LIC 622) . Five out of five residents' LIC 622 were not filled out correctly, which were missing Start Date (first date of medication assistance), and refills. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Deficiencies were cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Feb 8, 2024