Golden Age Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were three (3) staff and six (6) residents present. The LPA was greeted by staff and the LPA explained the reason for the visit. Staff contacted the Administrator via telephone. The Administrators, Siranush Alvadzhyan and Mary Mkrtchyan arrived shortly thereafter and the reason for the visit was explained. Entrance interview conducted. Starting at 01:15 p.m., the LPA along with 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. The following was observed: KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in locked metal containers on the kitchen counter. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be new and fully charged with a purchase date of 03/04/2026. Required postings were observed throughout the common space. Activities were observed in the living room and dining room. There is a working telephone on premises. Laundry room was observed locked and inaccessible at the time of the visit. Cleaning supplies and detergents were observed inaccessible to residents in care at the time of the visit. Report will continue on LIC809-C, 2ND PAGE. RESTROOMS: There are two (2) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 01:39 p.m., the hot water temperature was measured in both bathroom and they measured 113.7 and 113.5 degrees Fahrenheit. BEDROOMS: There are three (3) bedrooms for resident use. All bedrooms are designated as double occupancy / shared rooms. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA Observed Resident 1 (R1) in room 1 and Resident (R2) in room 3 with bed rails extending the entire length of the bed. BACKYARD: The backyard has a covered patio area with patio furniture for resident use. The LPA observed two (2) locked sheds for storage purposes. All passageways were observed to be clear of any obstructions. The facility is gated. No bodies of water noted at the time of the visit. INTERVIEWS: The LPA conducted six resident interviews, no immediate concerns were voiced at this time. RECORDS: The LPA reviewed Records at 2:00 p.m. The LPA reviewed five (5) out of six (6) resident files 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. The LPA observed that R1 and R2 were not receiving hospice services. File review also revealed that three (3) out of five (5) residents did not have updated appraisal/needs and service plans. The LPA reviewed five (5) out of seven (7) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, and criminal record clearances. The LPA checked the Guardian website and the Licensing Information System Facility Personnel Report Summary and observed that Staff 1 (S1) who was present during today's visit was not associated to the facility. Per S1 and the LIC500 they have been working at the facility since April 2026. Due to time constraints the LPA will return at a later date to complete the annual. 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. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were three (3) staff and six (6) residents present. The LPA was greeted by staff and the LPA explained the reason for the visit. Staff contacted the Administrator via telephone. The Administrators, Siranush Alvadzhyan and Mary Mkrtchyan arrived shortly thereafter and the reason for the visit was explained. Entrance interview conducted. Starting at 01:15 p.m., the LPA along with 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. The following was observed: KITCHEN: The LPA inspected the kitchen/food service area. Knives and sharps were observed in locked metal containers on the kitchen counter. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be new and fully charged with a purchase date of 03/04/2026. Required postings were observed throughout the common space. Activities were observed in the living room and dining room. There is a working telephone on premises. Laundry room was observed locked and inaccessible at the time of the visit. Cleaning supplies and detergents were observed inaccessible to residents in care at the time of the visit. Report will continue on LIC809-C, 2ND PAGE. RESTROOMS: There are two (2) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 01:39 p.m., the hot water temperature was measured in both bathroom and they measured 113.7 and 113.5 degrees Fahrenheit. BEDROOMS: There are three (3) bedrooms for resident use. All bedrooms are designated as double occupancy / shared rooms. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPA Observed Resident 1 (R1) in room 1 and Resident (R2) in room 3 with bed rails extending the entire length of the bed. BACKYARD: The backyard has a covered patio area with patio furniture for resident use. The LPA observed two (2) locked sheds for storage purposes. All passageways were observed to be clear of any obstructions. The facility is gated. No bodies of water noted at the time of the visit. INTERVIEWS: The LPA conducted six resident interviews, no immediate concerns were voiced at this time. RECORDS: The LPA reviewed Records at 2:00 p.m. The LPA reviewed five (5) out of six (6) resident files 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. The LPA observed that R1 and R2 were not receiving hospice services. File review also revealed that three (3) out of five (5) residents did not have updated appraisal/needs and service plans. The LPA reviewed five (5) out of seven (7) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, and criminal record clearances. The LPA checked the Guardian website and the Licensing Information System Facility Personnel Report Summary and observed that Staff 1 (S1) who was present during today's visit was not associated to the facility. Per S1 and the LIC500 they have been working at the facility since April 2026. Due to time constraints the LPA will return at a later date to complete the annual. 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. Exit interview was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 11, 2026

Allegation investigated: Licensee is not ensuring that the facility has a working refrigerator.

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint visit for the allegation listed above. Upon arrival LPA met with staff and explained the reason for the visit. Administrator Siranush arrived shortly after. At approx 09:30am LPA conducted physical plant, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation. It was reported that "Licensee is not ensuring that the facility has a working refrigerator" as it was alleged that the fridge was been in disrepair for an extended period of time. Interviews conducted with staff, Administrator and three (3) out of four (4) residents revealed that they all have not observed the fridge to be in disrepair for any amount of time. One (1) resident was sleeping during the visit. During physical plant, LPA observed staff preparing lunch with chicken and vegetables. LPA observed fridge to be sufficiently stocked with a temperature of 39 degrees. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Unsubstantiated Continued from 9099 Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Licensee is not ensuring that the facility has a working refrigerator” is deemed Unsubstantiated at this time. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 29-AS-20250624145650

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two (2) staff and four (4) residents present. The LPA was greeted by staff who then contacted the Administrator via telephone. The Administrator, Siranush Alvadzhyan arrived at approximately 11:00 a.m. and at this time, the reason for the visit was explained. Entrance interview conducted. Starting at 11:03 a.m., the LPA along with the Administrator 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. The following was observed: KITCHEN: The LPA inspected the kitchen/food service area at 11:10 a.m. Knives and sharps were observed in locked metal containers on the kitchen counter. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. The LPA observed the fire extinguisher to be new and fully charged with a purchase date of 04/30/2025. Report Continued on LIC809C... Report Continued from LIC 809... Required postings were observed throughout the common space. Activities were observed in the living room and dining room. There is a working telephone on premises. The LPA observed a locked closet in the hallway with additional clean linens, towels, and personal hygiene items. Laundry room was observed locked and inaccessible at the time of the visit. Cleaning supplies and detergents were observed inaccessible to residents in care at the time of the visit. RESTROOMS: There are two (2) restrooms for resident use. Bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Starting at 11:05 a.m., the hot water temperature was measured in both bathroom and they measured within the required range of 105 – 120 degrees Fahrenheit. BEDROOMS: There are three (3) bedrooms for resident use. All bedrooms are designated as double occupancy / shared rooms. All resident rooms were observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. BACKYARD: The backyard has a covered patio area with patio furniture for resident use. The LPA observed two (2) locked sheds for storage purposes. All passageways were observed to be clear of any obstructions. The facility is gated. No bodies of water noted at the time of the visit. RECORDS: The LPA reviewed Resident Records at 11:30 a.m. and Personnel Records at 12:05 p.m. Four (4) 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. All files were in order. Report Continued on LIC 809C... Report Continued from LIC 809C... Six (6) personnel files including the current Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate yearly training. All records were in order. Administrator’s certificate is valid until 03/19/2026 INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control plan. The facility’s policies and procedures as it pertains to infection control are adequate. The LPA also reviewed the facility's emergency disaster plan, which was observed to be complete and recently reviewed/updated. Emergency disaster drills conducted quarterly as per regulation; the last one conducted on 04/28/2025. MEDICATIONS: Medications review began at approximately 01:00 p.m. The medications are locked in a cabinet adjacent to the kitchen. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications appeared to be given as prescribed at the time of the visit. No citations issued. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 5, 2025

Allegation investigated: . The facility did not provide ‘awake night staff’ as agreed upon prior to admission. 2. Facility staff failed to ensure that the resident was assisted with the self-administration of their medication as prescribed 3. Staff did not pick up the resident’s medication timely from the pharmacy 4. Resident’s hygiene needs were not met 5. Staff fed resident too quickly which led to aspiration pneumonia 6. Staff failed to acknowledge residents' food preferences

Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to conduct further investigation for the above allegations and to deliver findings of the investigation and was let into the home by Karine Khachatryan, Staff. Siranush Alvadzhyan, Administrator was contacted by staff via telephone and advised of LPA Yee's visit. She arrived at 10:46am to conduct the visit. The reason for today's visit was explained. On the initial visit conducted on 2/16/2023, LPA Yee conducted interview with the Administratrator at 9:54am - 1:15pm, staff from 01:29 pm - 2:29pm and reviewed facility files beginning at 2:35pm - 3:10pm and obtained copies of facility documents relevant to the complaint. Residents were not interviewed on today's visit due to time constraints. On today's visit, LPA Yee conducted another interview with the Administrator at 10:55am, Staff #1 at Unsubstantiated 12:34pm, Resident #2 at 1:35pm, Resident #3 at 1:40pm, Resident #4 at 2:12pm, Resident #5 at 2:18pm and attempted to interview Resident #6 at 1:33pm and was unsuccessful. Resident #1 was never interviewed as the resident was no longer residing at the home when the complaint was received. Copies of facility documents were collected throughout the visit. Per information regarding allegation #1 - The facility did not provide ‘awake night staff’ as agreed upon prior to admission. Per review of the facility staff schedule, the facility has a awake staff who works the night shift from 8pm to 8am. Per interviews conducted, the staff who work the night shift, is awake and does room checks every 2-3 hours. Night staff also monitor residents who need to be observed depending on the needs of the resident. Per interviews conducted, Resident #1 would sleep for an hour and was awake most of the night and was monitored and supervised by staff. The facility does not have live in staff. There was insufficient evidence to support the allegation that the facility did not provide awake night staff, therefore the allegation is unsubstantiated. Per interviews conducted with staff and residents regarding allegation #2 - Facility staff failed to ensure that the resident was assisted with the self-administration of their medication as prescribed, residents interviewed stated that the facility staff store all their medications and dispense their medications in a timely manner. Residents interviewed were able to tell LPA Yee how many times during the day that they received their medications and have indicated that they have not had any issues with their medications. Per staff interviewed, medications prescribed on a cycle are dispensed to the residents as ordered by the physician. Resident #1 was prescribed Naproxen 375mg - 1 tab 2 twice a day and the resident was given the medication as prescribed. On 10/6/23, Temazepam was picked up by the Administrator and given to Resident #1 at bed time. The facility staff administered both medication as prescribed. Per interviews conducted, staff do not modify doctors orders and administer medications as prescribed. Changes are made to physician's order only if the doctor orders the change in writing. The staff indicated that they don't have any reason not to give the residents their medications. LPA Yee was not able to obtain sufficient evidence to support the allegation that facility staff failed to ensure that the resident was assisted with the self administration of their medication as prescribed, therefore the allegation is unsubstantiated at this time. Continued on LIC9099-C Allegation #3 alleges that Staff did not pick up the resident’s medication timely from the pharmacy and per interviews conducted with the Administrator, reveals that Resident #1 was prescribed Temazepam on 10/5/22. The pharmacy where the physician's order was sent electronically, did not have the medication in stock and had to order the medication and it would not be available until 10/6/22 and could not be picked up the same day. However, the family member of Resident #1, states that the physician's order was sent on 10/4/22 to the pharmacy and would have been ready for pick up the same day. It is unknown when the physician's order was actually transmitted to the pharmacy or if Temazepam was in stock on 10/4/22 for the same day pickup or if the prescribed medication would have had to be ordered as was the case on 10/5/22. The medication pickup the same day was delayed not due to the failure of the Administrator to pick up the medication but due to availability of the medication. There was insufficient evidence to support the allegation that staff did not pick up the resident's medication timely from the pharmacy, therefore the allegation is unsubstantiated at this time. The complaint continues to allege in allegation #4 that Resident’s hygiene needs were not met. Per interviews conducted with the Administrator, Staff #1 and residents, the residents are bathed 2 times a week or as requested or as needed. The residents clothing are changed every morning and changed into pajamas for bed. They ensure residents brush their teeth and the caregivers comb all the residents' hair. Sometimes residents' won't allow staff to help them. It is alleged that Resident #1 was observed to be disheveled and had food stuck in their teeth and this was not the norm for the resident. Per interviews conducted with staff, the resident would be bathed 2 times a week, changed and their hair combed. Resident #1 had insomnia and laying down would have given the resident the appearance of not being cleaned or having their hygiene needs met. The resident's appearance is not sufficient evidence to conclude that it was due to lack of hygiene care. There is insufficient evidence to support the allegation that the Resident's hygiene needs were not met, therefore the allegation is unsubstantiated at this time. Allegation #5 of the complaint alleges that Staff fed resident too quickly which led to aspiration pneumonia. Per review of medical records the resident was sent to the hospital on 10/8/22 for coughing, low oxygen and general weakness. It was determined at the time of the hospitalization that the primary diagnosis was that Resident #1 had aspiration pneumonia. The family member hypothesizes that the cause of the aspiration pneumonia was due to the facility staff being impatient and feeding Resident #1 very fast. Per this investigation, there was no conclusive evidence to establish that the staff's actions was the cause of Resident #1 aspiration pneumonia. Aspiration pneumonia can develop from just swallowing ones own saliva or vomit or coughing while eating and causing food to get into the lungs or other reasons. The investigation did not reveal that the aspiration pneumonia was the result of staff's action of feeding the resident fast. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. The last allegation on the complaint - allegation #6 the facility Staff failed to acknowledge residents' food preferences. Per investigation of the allegation, Resident #1 ate everything that was given to them. Resident did not refuse the food. Residents can also ask for something different if they do not like the food offered on the menu. Per the Administrator, family member never discussed food options for Resident #1 with her and was not aware that there was a problem with the food. Per review of the menu, the facility offers a variety of foods and also offers other food choices for birthdays and holidays. There was insufficient evidence to support the allegation that the facility failed to acknowledge residents' food preferences, therefore the allegation is unsubstantiated at this time. Although all the above allegations may have have happened or is valid, there was not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore the all the allegations were deemed UNSUBSTANTIATED at this time. No deficiencies were cited on today's visit. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 29, 2024 · control 29-AS-20230207135308

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA met with staff and explained the reason for the visit. The Licensee / Administrator Siranush Alvadzhyan arrived shortly after. The LPA 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. LPA inspected facility for fire safety, personal accommodations, and food service. The facility smoke alarm and combined carbon monoxide system is hard wired and was functional during the inspection. The fire extinguisher was observed to be fully charged and last purchased in 03/29/2024. LPA inspected kitchen at approx. 10am, Knives are kept inaccessible in lock boxes on the counter to the right of the fridge. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Cleaning products were observed stored inaccessible to residents in care. Emergency food was observed to be sufficient and stored in bottom cabinet to the right of the fridge. The common areas were appropriately furnished, and the lighting was adequate. There are games and/or activity supplies in the living room. There was sufficient space to accommodate indoor activities. Night lights were maintained in hallways and passageways to non-private bathrooms. LPA observed medication, residents and staff records to be kept inaccessible in locked cabinets to the left of the fridge. LPA observed required postings throughout the common spaces. The bedrooms were observed to be properly furnished with a bed, night stand, and sufficient lighting for each client The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Continued from 809 LPA observed bathroom to be clean, properly supplied and had functional fixtures. The hot water was measured in the bathrooms within 105 - 120 degrees Fahrenheit. The bathrooms were sufficiently stocked with supplies and paper towels. In the front lot of the facility, LPA observed a shaded patio with furniture designated for outdoor use. There were no bodies of water noted. The facility has one (1) shed in the backyard that is utilized for additional storage of cleaning supplies, furniture and other items for facility use. There is sufficient room to conduct outdoor activities. The exterior passageways were clean and clear of any obstructions. There is an additional structure in front of the facility that is being rented by independent individuals who do not require care and supervision. There is no backyard or bodies of water. The property is completely fenced and gated with access out of the property through a sliding gate and individual door located at the front of the driveway. There is no garage. Records review began at approx 10:30am, client records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were observed to be in order at this time. Last emergency disaster drill was conducted 04/26/2024. Medications review began at approximately approx. 11:30am. Medications were observed to be properly documented on the centrally stored medications and destruction record at this time. The first aid supplies were complete , including a thermometer and a current version of a first aid manual. First aid was observed to be stored inaccessible in the medication cabinet as well. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of COVID. 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 facility’s policies and procedures as it pertains to infection control are adequate at this time. During the visit, LPA interviewed staff and residents. LPA also obtained the following documents - Updated Limited Liability insurance. Exit interview conducted and copy of report issued.the state’s words, verbatim · CDSS document, May 17, 2024