Five Star Assisted Living Corp.

Allegation investigated: Facility did not issue a refund to resident's responsible party.

On 02/02/2026 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced complaint visit. LPA met by Direct Care Staff, Esther and Henry Alsisto explained reason for visit and was permitted entry into the facility. Licensee/Administrator, Jasmine Oganyan was contacted and arrived some time later. A tour of the facility was completed. A health and safety check was completed on residents in care. Residents were observed in common area and in rooms. There are currently 6 residents present during todays visit. 1 of 6 is bedridden and 3 of 6 are receiving hospice services at this time. During complaint investigation LPA completed interviews, reviewed admission agreements and incident reports. Interviews disclosed that R1 passed on 7/28/25 and their personal belongings were removed from the facility on 7/29/25. Licensee did not provide a refund to the responsible party as required by Title 22. Responsible party is owed a refund in the amount of $322.58. The preponderance of evidence standard has been met per California Code of Regulations, Title 22. The complaint allegation is SUBSTANTIATED.the state’s words, verbatim · CDSS document, Feb 2, 2026 · control 24-AS-20260126163939

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652 · Plan of correction due date: Feb 13, 2026

1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds (c) 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 was not met as evidence by: review of records and interviews completed. The licensee did not comply with the section cited above in that R1 passed on 7/28/25 and their belongings were removed from the facility on 7/29/25. Licensee did not provide a refund for the 2 days of the month that the resident did not reside at the facility in the amount of $322.58. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2026

Plan of correction: Licensee stated they will provide a refund to the responsible party in the amount of $322.58 via certified mail. A copy of the receipt will be provided to CCL by POC date as proof of correction.

Type of visit: Case Management - Deficiencies

On 02/02/2026 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced case visit. LPA met by Direct Care Staff, Esther and Henry Alsisto explained reason for visit and was permitted entry into the facility. Licensee/Administrator, Jasmine Oganyan was contacted and arrived some time later. A tour of the facility was completed. A health and safety check was completed on residents in care. Residents were observed in common area and in rooms. There are currently 6 residents present during todays visit. 1 of 6 is bedridden and 3 of 6 are receiving hospice services at this time. This case management visit is being conducted as follow up to complaint investigation for complaint #24-AS-20260126163939. During review of records for this complaint it was observed that the Licensee is not reporting incidents to the Department as required. Interviews conducted during complaint disclosed R1 passed on 07/28/2025. LPA reviewed incident reports for R1’s death. Death reports were not submitted by the Licensee from the period of 3/25/25 through 2/2/26. During interviews with Licensee and their spouse LPA observed them looking for copies of the death reports and fax confirmations however, they were unable to be located. Incident reports are not being submitted to the Department as required by Title 22. Deficiencies cited per California Code of Regulations, Title 22. If not corrected, deficiencies will pose a direct impact to residents in care. Exit interview completed with Licensee, Jasmine. A copy of this report, deficiencies and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 2, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(1) · Plan of correction due date: Feb 13, 2026

87211 Reporting Requirements (1) 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 report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case… This requirement was not met as evidence by: records reviewed, the licensee did not comply with the section cited above in that review of incident reports provided to the Department are not being completed. LPA reviewed incident reports for R1’s death. Death reports were not submitted by the Licensee from the period of 3/25/25 through 2/2/26. R1 passed on 7/28/25. This poses a potential health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2026

Plan of correction: Licensee stated they are currently providing reports to the Department via efax and they must not be going through. Licensee stated they will have to review their reporting by efax and come up with another method. Licensee stated they will provide all incident reports in person. Licensee stated they will contact customer service for the efax and provide a copy of the service order/receipt as proof of correction by POC date.

Type of visit: Required - 1 Year

On 01/21/2026 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA met by Direct Care Staff, Esther and Henry Alsisto explained reason for visit and was permitted entry into the facility. Administrator, Jasmine Oganyan was contacted and arrived some time later. A tour of the facility inside and out was completed. A health and safety check was completed on residents in care. Residents were observed in common area and in rooms. There are currently 6 residents present during todays visit. 1 of 6 is bedridden and 3 of 6 are receiving hospice services at this time. Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 8/4/2025. Last fire drill on conducted on 1/13/2026. Resident rooms observed to have the required furnishings and with adequate lighting. Sharps, chemicals and medications were located in locked cabinets/closets and cupboards. LPA observed sufficient seating under covered patio areas. The following issues were observed during today’s visit: 2 hair iron/straighteners observed in bathroom drawer unlocked and accessible to residents in care. Supplements observed unlocked and accessible to residents in care in the food pantry. Deficiencies cited per California Code of Regulations, Title 22. Deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care. CONT... CONT... LPA requested the following documents to be submitted to CCL by 01/30/2026: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), and a copy of the current liability insurance in order to update the facility file. Exit interview was conducted with Administrator, Maricia. A copy of this report, deficiencies, and appeal rights were discussed and provided to Administrator. A plan of correction was developed by Administrator and reviewed by LPA.the state’s words, verbatim · CDSS document, Jan 21, 2026

Type of visit: Required - 1 Year

On 5/12/23 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived unannounced for an annual inspection visit. LPAs were met by Direct Care Staff, Esther and Henry Alsisto explained reason for visit and was permitted entry into the facility. Administrator, Jasmine Oganyan was contacted and arrived some time later. LPAs completed a health and safety check on residents in care. LPA toured the facility inside and out. Residents observed in common areas and in rooms. There was 4 residents on hospice and 2 bedridden at the time of visit. Pathways and doors were clear and free from obstruction. Facility was clean and without odor. Common areas were clean, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operational at time of visit. Fire extinguisher last serviced 1/7/25. Last fire drill on 11/24/24. Resident rooms observed to have the required furnishings and with adequate lighting. Linen supplies are kept in linen closets. LPA observed sufficient seating under covered patio areas. The following issues were observed during time of visit: Facility sketch needs meeting point designated. 2 of 6 residents observed with hospital beds with hand railings and not on hospice. Bathroom #2 floor is not slip-resistant. Air vents in Bathroom #2 is rusted/dirty and in need of cleaning/replacement. Bathroom #2 baseboard in need of repair/replacement. Bathroom #2 light switch broken and in need of repair. Fence on right side leaning and in need of repair. Debris observed in pool area in need of removal. Concrete walkway in back of house observed with a lip (possible tripping hazard) in need of repair. Debris observed by storage shed in need of removal. CONT... CONT... Chemicals/sharps/items posing danger to residents observed throughout the facility unlocked and accessible. First Aid kit missing instruction guide. Bedroom #6 observed with a broken window in need of repair. Pool fence in need of repair. Quick release bars observed on windows. An immediate danger was not observed for pool fence due to the non-ambulatory status of the residents and their inability to leave the facility without assistance. The Department will review original fire clearance for approval of window bars. If deficiency is warranted, they will be issued at a later time. Immediate civil penalty assessed in the amount of $500 for bedridden resident. LPA requested the following documents to be submitted to CCL by 1/31/25: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-E), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file. Exit interview completed with Administrator, Jasmine. A copy of this report, deficiencies and TV's provided.the state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Required - 1 Year

On 01/22/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with caregiver Henry Alsisto. LPA toured facility with caregiver. Administrator Jasmine Oganyan was called and arrived during tour. All six residents present during inspection. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Fire extinguisher was observed with a served date: 2/2023. An adequate supply of perishable and non-perishable food was observed. Medications were observed kept locked in kitchen cabinet. Knives and cleaning chemicals were observed locked under kitchen sink. Refrigerator temperature observed maintained at 28 degree F and freezer temperature maintained at -10 degree F. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured. All bathrooms were observed operating and functioning during inspection. Non-skid mat and grabbed bars were observed. Hot water temperature was tested between range 106.6 and 109.4 degrees in master bathroom. Hot water temperature was tested at 112.4 in bathroom. Extra linens were observed. Outside of facility toured. Side gate was observed self-closing and free of debris. Adequate outdoor seating available for residents. Due to time constrain, LPA will return at later date for an Annual continuation inspection. No deficiencies cited during today’s visit. Exit Interview conducted. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of these report.the state’s words, verbatim · CDSS document, Jan 22, 2024